What is the treatment for a human bite?

Treatment of Human Bites

Human bite wounds should be treated with copious irrigation using water or saline, followed by prophylactic antibiotics regardless of the wound's appearance, with amoxicillin-clavulanate being the first-line oral therapy. 1

Initial Management

• Immediately irrigate the bite wound with copious amounts of fluid (water or saline) to minimize bacterial infection risk 1
• Clean the wound thoroughly with sterile normal saline to remove superficial debris (avoid iodine or antibiotic-containing solutions) 1
• Do not close infected wounds; for non-infected wounds seen early (<8 hours), consider approximation with Steri-Strips rather than sutures 1
• Facial wounds are an exception and may be closed primarily after meticulous wound care, irrigation, and prophylactic antibiotics 1

Antibiotic Therapy

Oral Therapy (Outpatient)

• First-line: Amoxicillin-clavulanate 1, 2
• Alternatives (if allergic to penicillin):
  • Doxycycline 1
  • Penicillin VK plus dicloxacillin 1
  • Fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin) plus an anaerobic agent (metronidazole or clindamycin) 1, 3

Intravenous Therapy (Inpatient)

• First-line: β-lactam/β-lactamase combinations (ampicillin-sulbactam, piperacillin-tazobactam) 1
• Alternatives:
  • Second-generation cephalosporins (cefoxitin) 1
  • Carbapenems (ertapenem, imipenem, meropenem) 1

Medications to Avoid

• First-generation cephalosporins (cephalexin) 1
• Penicillinase-resistant penicillins (dicloxacillin) 1
• Macrolides (erythromycin) 1
• Clindamycin alone (poor coverage against common pathogens) 1

Special Considerations

Clenched-Fist Injuries

• Require expert hand evaluation for potential penetration into synovium, joint capsule, or bone 1, 2
• Often more serious and typically require surgical intervention and intravenous antibiotics 2
• Higher risk of complications including septic arthritis and osteomyelitis 1, 4

Wound Complications

• Monitor for signs of infection, which occurs in approximately 10% of human bite wounds 2, 5
• Common pathogens include streptococci (especially viridans), staphylococci, Haemophilus species, Eikenella corrodens, and anaerobes 1, 3
• Infectious complications may include cellulitis, septic arthritis, osteomyelitis, subcutaneous abscess, tendonitis, and rarely bacteremia 1, 4

Additional Measures

• Ensure tetanus prophylaxis is current; administer tetanus toxoid (0.5 mL intramuscularly) if outdated or unknown status 1
• Elevate the injured body part, especially if swollen, to accelerate healing 1
• Follow up within 24 hours either by phone or office visit for outpatients 1
• Consider hospitalization if infection progresses despite appropriate antimicrobial therapy 1
• For complicated infections (osteomyelitis, septic arthritis), extend treatment duration to 4-6 weeks for osteomyelitis and 3-4 weeks for synovitis 1

Pediatric Considerations

• Human bites are common in children, often resulting from fights or aggressive play 6
• Management principles are the same as for adults, with appropriate dose adjustments for antibiotics 6

Human bites should never be underestimated as they can lead to serious infections due to their polymicrobial nature and the potential for transmission of infectious diseases 4.