What is the treatment for a self-inflicted bite wound?

Treatment of Self-Inflicted Bite Wounds

Self-inflicted bite wounds should be evaluated in a medical facility as soon as possible due to the high risk of infection from human oral bacteria. 1

Initial Management

• Thoroughly irrigate the wound with running tap water or sterile saline solution until all visible debris and foreign matter are removed 1
• Do not use antiseptic agents such as povidone-iodine for irrigation, as they have not demonstrated additional benefit over tap water or saline 1
• Human bite wounds are at high risk for infection due to the diverse oral flora, including streptococci, staphylococci, Haemophilus species, and Eikenella corrodens 1

Wound Care

• Do not close infected wounds, as this may lead to abscess formation 1
• For clean wounds, cover with an occlusive dressing (film, petrolatum, hydrogel, or cellulose/collagen) to promote healing 1
• Early suturing of human bite wounds (within 8 hours) is controversial; approximation with Steri-Strips and delayed closure is generally preferred 1
• Facial bite wounds are an exception and may be closed primarily after meticulous wound care, copious irrigation, and prophylactic antibiotics 1, 2

Antibiotic Therapy

• Early administration of antibiotics is recommended for all human bite wounds regardless of wound appearance 1
• For outpatient treatment, amoxicillin-clavulanate is the recommended first-line therapy 1
• Alternative oral options include doxycycline, or a combination of penicillin VK plus dicloxacillin 1
• Avoid first-generation cephalosporins, penicillinase-resistant penicillins, macrolides, and clindamycin as they have poor activity against common pathogens 1

Special Considerations

• Ensure tetanus prophylaxis is current; if outdated or unknown, administer tetanus toxoid (0.5 mL intramuscularly) 1
• Elevate the injured body part, especially if swollen, to accelerate healing 1
• For hand wounds, which are often more serious, consider evaluation by a hand specialist to assess for penetration into synovium, joint capsule, or bone 1, 3
• Monitor for signs of infection: redness, swelling, foul-smelling drainage, increased pain, or fever 1

When to Seek Additional Care

• If signs of infection develop despite treatment, remove the dressing, inspect the wound, and seek medical care 1
• Complications requiring prolonged therapy include septic arthritis (3-4 weeks of antibiotics), osteomyelitis (4-6 weeks), tendonitis, and subcutaneous abscess formation 1
• Pain disproportionate to the severity of injury but located near a bone or joint should prompt evaluation for periosteal penetration 1

Follow-up

• Outpatients should be followed up within 24 hours either by phone or during an office visit 1
• If infection progresses despite appropriate antimicrobial and ancillary therapy, hospitalization should be considered 1

Remember that human bite wounds have a higher risk of infection than many other types of wounds due to the diverse oral flora and should be treated aggressively to prevent complications 1, 4, 5.