Duration of Antibiotic Treatment for Human Bites in Children
For human bites in children requiring antibiotic treatment, administer a 7-10 day course of oral amoxicillin-clavulanate (25 mg/kg/day of the amoxicillin component in 2 divided doses), or if parenteral therapy is needed, ampicillin-sulbactam (1.5-3.0 g every 6 hours IV for adults, weight-adjusted for children) for the same duration. 1
Antibiotic Selection and Dosing
First-line oral therapy:
- Amoxicillin-clavulanate is the preferred agent because it covers the polymicrobial flora of human bites, including Eikenella corrodens (resistant to first-generation cephalosporins and clindamycin), Staphylococcus aureus, streptococci, and anaerobes 1, 2
- Pediatric dosing: 25 mg/kg/day of the amoxicillin component in 2 divided doses 1
- Adult dosing: 875/125 mg twice daily 1
Parenteral alternatives for severe infections:
- Ampicillin-sulbactam: 1.5-3.0 g every 6 hours IV (weight-adjusted for children) 1
- Carbapenems (ertapenem, imipenem, meropenem) are also effective but should be reserved for more severe cases 1
For penicillin-allergic patients:
- Doxycycline 100 mg twice daily (not recommended for children <8 years) provides good activity against Eikenella species, staphylococci, and anaerobes, though some streptococci may be resistant 1
- Alternative: Fluoroquinolone (ciprofloxacin or levofloxacin) plus metronidazole, or moxifloxacin as monotherapy 1
Treatment Duration Algorithm
7-10 days is the standard duration for human bite infections 1
The decision pathway:
- Superficial, uninfected wounds seen early (<24 hours): Prophylactic antibiotics may not be necessary, as studies show most superficial human bites in children do not become infected 3
- High-risk wounds requiring prophylaxis or treatment: 7-10 days of therapy 1
- Established infection at presentation: Full 7-10 day course, with consideration for IV therapy initially if severe 3
- Clenched-fist injuries (CFI): These require aggressive management with surgical debridement when possible and IV antibiotics, potentially requiring hospitalization 4, 5
Critical Risk Stratification
High-risk wounds requiring antibiotic treatment include: 1
- Puncture wounds (deeper tissue penetration)
- Hand injuries, especially clenched-fist injuries
- Wounds involving joints, tendons, or bones
- Wounds in immunocompromised patients
- Wounds presenting >12-24 hours after injury
- Already infected wounds at presentation
Low-risk wounds (may not require antibiotics):
- Superficial abrasions of the face seen shortly after injury have infection rates <3% 5
- Minor wounds seen within hours of injury in immunocompetent children 3
Common Pitfalls to Avoid
- Do not use first-generation cephalosporins (cephalexin, cefazolin) alone for human bites, as they miss Eikenella corrodens, a common pathogen in human oral flora 1
- Do not use clindamycin monotherapy despite its good staphylococcal and anaerobic coverage, as it also misses E. corrodens 1
- Do not dismiss superficial bites as benign without follow-up, as serious infections can develop even in seemingly minor wounds 3
- Ensure tetanus prophylaxis is current (within 10 years); administer Tdap if not previously given 1
Special Considerations for Children
- The infection rate for human bites in children is approximately 10% overall 2
- Most human bites in children are superficial facial abrasions inflicted by other children and have low infection rates when properly managed 3, 5
- Compliance with three-times-daily dosing can be challenging; twice-daily amoxicillin-clavulanate is equally effective and may improve adherence 6
- All bite wounds require follow-up regardless of initial severity, as established infections may worsen or new infections may develop 3