What is the recommended medication treatment for a large animal or human bite?

Medication Treatment for Large Bite Wounds

Immediate Wound Management

All animal and human bite wounds should be evaluated at a medical facility as soon as possible, with thorough irrigation and prophylactic antibiotics initiated early for high-risk wounds. 1

Initial Wound Care

• Irrigate the wound thoroughly with running tap water or sterile saline until all visible debris and foreign matter is removed 1
• Clean with sterile normal saline to remove superficial debris; avoid povidone-iodine or antibiotic-containing solutions as they show no additional benefit over simple irrigation 1
• Do not close infected wounds; for fresh wounds (<8 hours), consider approximation with Steri-Strips rather than sutures to allow drainage 1, 2
• Facial wounds are an exception and may be closed primarily after meticulous care, provided prophylactic antibiotics are given 1, 2

Antibiotic Therapy

First-Line Oral Treatment

Amoxicillin-clavulanate is the first-line oral antibiotic for both animal and human bite wounds 2, 3

• This combination provides coverage against Pasteurella multocida (animal bites), Staphylococcus aureus, Streptococcus species, Eikenella corrodens (human bites), and anaerobes 1, 2
• Antibiotic prophylaxis should be given to ALL human bite wounds regardless of appearance, as they carry 20-25% infection risk 1, 2
• For animal bites, prophylaxis is indicated for: deep wounds, hand/foot/face/genital injuries, wounds near joints, immunocompromised patients, and wounds with tissue crushing 1

Alternative Oral Regimens (Penicillin Allergy)

• Doxycycline 100 mg twice daily 2, 4
• Fluoroquinolones (ciprofloxacin, levofloxacin, or moxifloxacin) PLUS metronidazole or clindamycin for anaerobic coverage 2, 3
• Moxifloxacin alone offers excellent coverage of the pathogenic flora 3

Intravenous Therapy (Severe Infections)

• First-line IV: Ampicillin-sulbactam or piperacillin-tazobactam 2
• Alternatives: Second-generation cephalosporins (cefoxitin) or carbapenems (ertapenem, imipenem, meropenem) 2
• IV therapy is indicated for patients with systemic signs of infection, severe cellulitis, joint/bone involvement, or immunocompromised status 1

Treatment Duration

• Standard prophylaxis/treatment: 3-5 days for uncomplicated wounds 1
• Septic arthritis: 4 weeks 1, 2
• Osteomyelitis: 6 weeks 1, 2

Essential Adjunctive Measures

Tetanus Prophylaxis

Administer tetanus toxoid (0.5 mL intramuscularly) if vaccination status is outdated or unknown 1, 2

Rabies Prophylaxis

• Consider for all feral and wild animal bites; consult local health department 1
• For suspected rabies exposure in previously unvaccinated persons: administer rabies immune globulin (20 IU/kg) infiltrated around the wound PLUS rabies vaccine series on days 0,3,7,14, and 28 1, 2
• Rabies transmission from human bites is extraordinarily rare in the United States and typically not a concern 2

Wound Elevation and Follow-Up

• Elevate the injured extremity using a sling (outpatient) or tubular stockinet with IV pole (inpatient) to reduce swelling 1
• Follow up within 24 hours by phone or office visit 1, 2
• If redness, swelling, foul drainage, increased pain, or fever develops, remove dressing and obtain immediate medical care 1

High-Risk Wounds Requiring Special Attention

Clenched-Fist Injuries

These require expert hand surgery evaluation for potential penetration into synovium, joint capsule, or bone 1, 2

• Carry highest risk for septic arthritis and osteomyelitis 1
• Often require hospitalization and IV antibiotics 2

Hand Bites

• Meta-analysis demonstrates prophylactic antibiotics reduce infection rates specifically for hand bites 1
• Hand wounds should never be closed primarily due to high infection risk 1

Common Pitfalls to Avoid

• Do not use pressure irrigation as it may drive bacteria deeper into tissues 1
• Do not exceed recommended antibiotic doses, as this increases side effects without benefit 4
• Do not delay antibiotic administration—early treatment (especially for human bites) prevents infection 1
• Do not use rigid cervical collars or spinal immobilization for penetrating bite trauma 1