What antibiotic treatment is recommended for a bleeding bite wound on the hand?

Amoxicillin Alone is INCORRECT for Bite Wounds to the Hand

The provider should NOT use amoxicillin (Ammocil) alone for this bleeding hand bite wound—amoxicillin-clavulanate is the required antibiotic because bite wounds contain both aerobic and anaerobic bacteria that plain amoxicillin cannot adequately cover. 1

Why Amoxicillin Alone Fails

Plain amoxicillin lacks activity against:

• Beta-lactamase producing bacteria commonly found in bite wounds, including Staphylococcus aureus and many anaerobes 1
• Key pathogens like Pasteurella multocida (in animal bites) that may produce beta-lactamases 1
• The polymicrobial nature of bite wounds requires coverage of both aerobic and anaerobic organisms 1

Correct Antibiotic Choice

Amoxicillin-clavulanate 875/125 mg twice daily is the recommended first-line oral therapy for bite wounds, with strong evidence supporting this choice 1. The clavulanate component inhibits beta-lactamases and provides the necessary anaerobic coverage 1.

Dosing

• Adults: 875 mg/125 mg orally twice daily 1, 2
• Duration: 3-5 days for prophylaxis in high-risk wounds 1
• Should be taken at the start of meals to enhance absorption and minimize GI intolerance 2

Why This Hand Bite is High-Risk

This patient requires preemptive antimicrobial therapy because hand bites specifically meet high-risk criteria 1:

• Location: Hand wounds have higher infection rates and risk of serious complications (septic arthritis, osteomyelitis, tenosynovitis) 1
• Bleeding wound: Indicates moderate severity injury 1
• Potential deep penetration: May have violated periosteum or joint capsule 1

The Infectious Diseases Society of America specifically identifies hand injuries as requiring prophylactic antibiotics, with a Cochrane review supporting this recommendation 1.

Alternative Antibiotics (if amoxicillin-clavulanate unavailable)

Intravenous options:

• Ampicillin-sulbactam 1.5-3.0 g every 6-8 hours 1
• Piperacillin-tazobactam 3.37 g every 6-8 hours 1

Oral alternatives for penicillin allergy:

• Doxycycline 100 mg twice daily (excellent against P. multocida but some streptococci resistant) 1
• Moxifloxacin 400 mg daily (provides good anaerobic coverage as monotherapy) 1
• Levofloxacin 750 mg daily PLUS metronidazole 500 mg three times daily 1

Critical Pitfalls to Avoid

Do NOT use these antibiotics alone as they have poor activity against bite wound pathogens 1:

• First-generation cephalosporins (cephalexin) - miss P. multocida 1
• Dicloxacillin alone - miss P. multocida 1
• Clindamycin alone - miss P. multocida 1
• Macrolides (erythromycin) - inadequate coverage 1

Additional Essential Management

Beyond correcting the antibiotic choice 1:

• Wound care: Copious irrigation with sterile saline, cautious debridement 1
• Do NOT primarily close hand bite wounds (high infection risk); may approximate margins only 1
• Tetanus prophylaxis: If not vaccinated within 10 years, give Tdap (preferred) or Td 1
• Rabies consideration: Consult local health officials if animal bite from feral/wild animal 1
• Elevation: Keep hand elevated to reduce swelling and accelerate healing 1
• Close follow-up: Within 24 hours to assess for infection progression 1

Evidence Quality Note

The recommendation for amoxicillin-clavulanate carries a "strong" recommendation with "moderate" quality evidence from the 2014 IDSA guidelines 1, which remain the most authoritative source and are reinforced by the 2024 WHO essential medicines guidelines 1. Hand bites specifically showed reduced infection rates with prophylactic antibiotics in meta-analyses 1.

Human bite wounds to the hand that present late (>24 hours) or with established infection have complication rates up to 27% even with appropriate therapy, emphasizing the importance of correct initial antibiotic selection 3.