Treatment of Pig Bites
Immediately irrigate the wound thoroughly with copious amounts of soap and water, administer prophylactic antibiotics (amoxicillin-clavulanate as first-line), and provide tetanus prophylaxis based on immunization status. 1, 2, 3
Immediate Wound Management
Perform aggressive irrigation and cleansing immediately with soap and water or sterile saline—this is the single most important intervention to prevent infection and reduce rabies risk 1, 4
The mechanical action of irrigation is more critical than the specific fluid used; copious volume is key to removing bacteria and debris 2, 5
Avoid iodine or antibiotic-containing solutions during initial cleansing, as these may damage underlying tissues 4
Debride devitalized tissue carefully, as inadequate debridement significantly increases infection risk 2, 5
Wound Closure Decision
Do NOT close infected wounds or wounds with significant tissue crushing 3, 6
For clean wounds presenting within 8 hours, consider approximation with Steri-Strips rather than sutures to minimize infection risk 3
Facial wounds are an exception: these may be closed primarily after meticulous irrigation and with prophylactic antibiotics, given cosmetic considerations 3, 6
Delay in presentation beyond 24 hours is not an absolute contraindication to closure, but excessive edema or tissue crushing mandates delayed closure 6
Antibiotic Therapy
Administer prophylactic antibiotics early regardless of wound appearance due to high infection risk from polymicrobial oral flora 2, 3, 4
First-line: Amoxicillin-clavulanate (covers typical oral flora including anaerobes) 2, 3
Penicillin-allergic patients: Use doxycycline, or a fluoroquinolone (ciprofloxacin/levofloxacin/moxifloxacin) plus metronidazole or clindamycin 3
For severe infections requiring IV therapy: Ampicillin-sulbactam, piperacillin-tazobactam, or carbapenems (ertapenem, imipenem, meropenem) 2, 3, 5
Tetanus Prophylaxis
Administer tetanus toxoid (0.5 mL intramuscularly) if vaccination status is outdated or unknown 2, 3, 4
All pig bite wounds warrant tetanus prophylaxis consideration given the contaminated nature of the injury 1, 7, 5
Rabies Considerations
Assess rabies risk based on the pig's vaccination status and whether the attack was provoked or unprovoked 1, 4
If rabies exposure is suspected in an unvaccinated patient, administer both rabies immune globulin (HRIG) at 20 IU/kg and rabies vaccine 1, 3, 4
HRIG dosing: Infiltrate up to half the dose around the wound if anatomically feasible; administer the remainder intramuscularly in the gluteal area 1
Vaccine regimen: Five 1-mL doses intramuscularly (deltoid in adults, anterolateral thigh acceptable in children) on days 0,3,7,14, and 28—never use the gluteal area for vaccine 1, 4
HRIG should only be given once at the beginning of prophylaxis, and can be administered up to day 7 after the first vaccine dose 1
Special Considerations and Pitfalls
Pig bites can cause devastating injuries including abdominal evisceration, particularly in children—maintain high suspicion for deep tissue injury 8
Deep wounds involving extremities require careful evaluation for penetration into joints, tendons, or bone 3, 8
Prehospital care is crucial as pig bites often occur in rural settings with prolonged transport times 8, 7
Common pitfall: Underestimating infection risk—pig bites have high bacterial load and require aggressive prophylaxis even if initially appearing minor 2, 5
Follow up within 24 hours to monitor for signs of infection, which may necessitate hospitalization and IV antibiotics 3
For complicated infections (osteomyelitis, septic arthritis), extend antibiotic treatment to 4-6 weeks for osteomyelitis and 3-4 weeks for synovitis 3