What is the proper treatment for an animal bite?

Animal Bite Management

Immediately clean the wound thoroughly with soap and water, assess rabies risk based on the animal species and availability for observation, and initiate rabies post-exposure prophylaxis (PEP) with both rabies immune globulin and vaccine for high-risk bites while considering antibiotic prophylaxis for infection-prone wounds. 1

Immediate Wound Care

• Copiously irrigate all bite wounds with soap and water immediately—this is the single most effective measure for preventing rabies and reducing infection risk 1, 2
• Use a 20-mL or larger syringe with normal saline for irrigation, or attach a 20-gauge catheter to the syringe for adequate pressure 2
• Explore the wound for tendon or bone involvement and foreign bodies 2
• Update tetanus prophylaxis as indicated 1, 3

Rabies Risk Assessment and Management

Dogs, Cats, and Ferrets

• If the animal is healthy and available: confine and observe for 10 days without administering rabies vaccine to the animal 4, 5
• Do not initiate rabies PEP in the victim during this observation period unless the animal develops signs of rabies 4, 1
• If the animal is rabid, suspected rabid, or unavailable for observation: immediately initiate rabies PEP with both rabies immune globulin (RIG) and vaccine 1
• Any stray or unwanted animal that bites may be euthanized immediately and the head submitted for rabies testing 4

Wild Animals and Bats

• Regard all bites from skunks, bats, foxes, coyotes, raccoons, bobcats, and other carnivores as rabid unless proven negative by laboratory testing 1
• Initiate rabies PEP immediately with both RIG and vaccine 1
• For bat exposures specifically: consider rabies PEP for any physical contact when bite or mucous membrane contact cannot be excluded, as bat bites may be undetectable 1

Rodents and Lagomorphs

• Bites from squirrels, hamsters, guinea pigs, gerbils, chipmunks, rats, mice, rabbits, and hares almost never require rabies prophylaxis 1
• Consult local public health officials for individual case assessment 1

Rabies Post-Exposure Prophylaxis Protocol

• Administer RIG at 20 IU/kg body weight, infiltrating as much as possible around the wound, with remainder given intramuscularly at a site distant from vaccine administration 1
• Give rabies vaccine on days 0,3,7, and 14 1, 2
• RIG can be administered through day 7 after the first vaccine dose; beyond day 7, RIG is not indicated as antibody response to vaccine is presumed 1
• Previously immunized individuals with documented adequate antibody titers require vaccine only, not RIG 1

Infection Prevention

Antibiotic Prophylaxis Indications

• High-risk wounds requiring prophylaxis include: 2
  • Cat bites (high infection risk due to deep puncture nature)
  • Puncture wounds of any type
  • Hand wounds
  • Wounds in immunosuppressed patients
  • "Dirty" wounds or those presenting late

Antibiotic Selection

• Amoxicillin-clavulanate is the first-line prophylactic antibiotic for animal bites 2
• Provides coverage against Pasteurella multocida (most common in cat and dog bites), Staphylococcus, Streptococcus, and anaerobes 3, 6
• For human bites, use a penicillinase-resistant penicillin, cephalosporin, or erythromycin to cover staphylococci and streptococci 3

Wound Closure Decisions

• Close wounds that are cosmetically favorable (such as facial wounds) or gaping wounds 2
• Consider leaving high-risk wounds open: puncture wounds, hand wounds, cat bites, and wounds presenting late 2, 6

Critical Pitfalls to Avoid

• Never delay reporting animal bites to local health authorities, especially when the animal shows signs of illness 5
• Do not administer rabies vaccine to the biting animal during the 10-day observation period—this can confuse clinical signs of rabies with vaccine side effects 5
• Do not underestimate cat bites—they have higher infection rates than dog bites due to their puncture nature 2, 6
• Human bites to the hand require aggressive management due to high complication rates; consider them separately from other human bites 6
• Most states require mandatory reporting of animal bites by physicians 2

Exposure Type Classification

• Bite exposure: any penetration of skin by teeth, regardless of severity 1
• Non-bite exposure: scratches, abrasions, open wounds, or mucous membranes contaminated with saliva or brain tissue from a rabid animal 1
• Casual contact (petting), or contact with blood, urine, or feces does not constitute exposure and does not require prophylaxis 1