What is the treatment guideline for a parrot or bird bite with associated pain and swelling?

Treatment Guidelines for Parrot/Bird Bite with Pain and Swelling

For parrot or bird bites with pain and swelling, treatment should include thorough wound cleansing with sterile normal saline, appropriate antibiotic therapy with amoxicillin-clavulanate, tetanus prophylaxis if needed, and elevation of the affected area to reduce swelling. 1, 2

Initial Wound Management

• Cleanse the wound thoroughly with sterile normal saline (no need for iodine or antibiotic-containing solutions) and remove superficial debris 1
• Deeper debridement is usually unnecessary unless there is significant contamination, and if performed, should be done cautiously to avoid enlarging the wound 1
• Do not close infected wounds; for early wounds (<8 hours), approximation of margins with Steri-Strips and subsequent closure by either delayed primary or secondary intent is recommended 1
• Elevate the injured body part, especially if swollen, to accelerate healing 1

Antibiotic Therapy

• Amoxicillin-clavulanate is the recommended first-line antibiotic for parrot bites, as standard antibiotic prophylaxis with amoxicillin/clavulanic acid is necessary to cover the specific pathogens transmitted by parrot bites 2
• First-generation cephalosporins (e.g., cephalexin), penicillinase-resistant penicillins (e.g., dicloxacillin), macrolides (e.g., erythromycin), and clindamycin have poor activity against common pathogens in animal bites and should be avoided 1
• For patients with penicillin allergies, alternative options include doxycycline or a fluoroquinolone (ciprofloxacin, levofloxacin) plus metronidazole for anaerobic coverage 1
• For severe infections requiring intravenous therapy, options include β-lactam/β-lactamase combinations (ampicillin-sulbactam), piperacillin/tazobactam, second-generation cephalosporins (cefoxitin), or carbapenems 1

Tetanus Prophylaxis

• Ensure tetanus prophylaxis status is current; if outdated or unknown, administer tetanus toxoid (0.5 mL intramuscularly) 1
• Tetanus, diphtheria, and pertussis (Tdap) is preferred over Tetanus and diphtheria (Td) if the former has not been previously given 1

Follow-up Care

• Outpatients should be followed up within 24 hours either by phone or during an office visit 1
• If infection progresses despite good antimicrobial and ancillary therapy, hospitalization should be considered 1
• Monitor for complications such as septic arthritis, osteomyelitis, subcutaneous abscess formation, tendonitis, and bacteremia 1

Special Considerations for Parrot/Bird Bites

• Bird bites, particularly from parrots, require specific consideration as they can transmit unique pathogens not covered by standard antibiotic regimens for common animal bites 2
• Pain disproportionate to the severity of injury but located near a bone or joint should suggest periosteal penetration, which may require more aggressive management 1
• Hand wounds from bird bites are often more serious than wounds to fleshy parts of the body and may require more aggressive treatment and longer courses of antibiotics 1, 2

Potential Complications

• Infectious complications include septic arthritis, osteomyelitis, subcutaneous abscess formation, tendonitis, and rarely bacteremia 1
• Noninfectious complications include nerve or tendon injury, compartment syndromes, postinfectious and traumatic arthritis, fracture, and bleeding 1
• Wound complications may necessitate prolonged therapy: 4-6 weeks for osteomyelitis and 3-4 weeks for synovitis 1

Prevention of Psittacosis (when dealing with parrots)

• Be aware that parrots can potentially transmit Chlamydia psittaci, which causes psittacosis 1
• When handling potentially infected birds, wear protective clothing, gloves, and appropriate respiratory protection 1
• If respiratory illness develops in a person exposed to birds, a physician should initiate early and specific treatment for psittacosis 1