What is the treatment for a human bite?

Treatment of Human Bites

The treatment of human bites requires immediate thorough irrigation with water or saline, followed by prophylactic antibiotics (amoxicillin-clavulanic acid) regardless of wound appearance, and tetanus prophylaxis if vaccination status is outdated or unknown. 1

Initial Wound Management

• Immediate and thorough irrigation with copious amounts of water or saline is critical to minimize bacterial infection risk by mechanically removing bacteria from the wound 1
• The mechanical action of irrigation is more important than the specific irrigation fluid used 1
• Inadequate irrigation and debridement significantly increases infection risk, making this step crucial in management 1, 2
• For facial bite wounds, gentle irrigation with water or dilute povidone-iodine solution can markedly decrease infection risk 3

Antibiotic Therapy

• Prophylactic antibiotics should be administered early regardless of wound appearance due to the high infection risk associated with human bites 1, 4
• Amoxicillin-clavulanic acid is the first-line antibiotic treatment as it effectively covers the polymicrobial flora typically found in human bites, including Eikenella corrodens 1, 3
• For patients with penicillin allergies, alternative options include carbapenems and doxycycline 1
• Severe infections or cases requiring intravenous therapy should be treated with ampicillin-sulbactam, piperacillin-tazobactam, or carbapenems 1, 4
• Human bite infections are typically polymicrobial with mixed aerobic and anaerobic species, requiring broad-spectrum coverage 5

Wound Closure Considerations

• Primary surgical repair is the treatment of choice for most clinically uninfected facial bite wounds 3
• Delayed closure should be reserved for high-risk or already infected wounds 3
• The decision to suture should consider cosmetic factors, potential for bacterial infections, wound size, location, and time since the bite 3
• Infected wounds should not be closed 3
• Clenched fist injuries (when a person's fist strikes another person's teeth) are among the most serious human bites and often require surgical intervention and intravenous antibiotic therapy 4

Tetanus Prophylaxis

• Tetanus prophylaxis should be administered based on the patient's immunization status 1
• If tetanus vaccination status is outdated or unknown, administer tetanus toxoid (0.5 mL intramuscularly) 1

Special Considerations

• Human bites to the hand have a higher risk of serious infections and complications compared to bites at other locations 5
• Children commonly sustain human bites during fights or aggressive play, with most wounds occurring on the upper extremities, followed by the face and neck 6
• Avulsive injuries with significant tissue loss represent the most difficult cases and are more likely to require hospitalization 3
• Approximately 10% of human bite injuries become infected, with potential complications ranging from cellulitis to osteomyelitis 4

Follow-up Care

• All bite wounds should be monitored for signs of infection, which may require more aggressive treatment 3, 4
• Early treatment, appropriate prophylaxis, and surgical evaluation are key to achieving desired treatment outcomes 2