What is the treatment for a possum bite?

Possum Bite Treatment

Treat possum bites with immediate thorough wound irrigation, amoxicillin-clavulanate prophylaxis (especially for hand wounds or puncture wounds), tetanus prophylaxis if needed, and rabies risk assessment with local health authorities, as possums are potential rabies vectors in certain regions.

Immediate Wound Management

• Irrigate the wound immediately and copiously with sterile normal saline or water to mechanically remove bacteria and debris—this is the single most critical intervention to prevent infection 1
• Avoid using iodine or antibiotic-containing solutions for routine cleansing, as these can damage tissue 1
• Remove only superficial debris; avoid aggressive debridement that could enlarge the wound 1
• Do not close infected wounds or puncture wounds; for clean wounds seen within 8 hours, use Steri-Strips rather than sutures 2, 1
• Facial wounds are the exception and may be closed primarily after meticulous irrigation and prophylactic antibiotics 2, 1
• Elevate the injured extremity to reduce swelling and accelerate healing 1

Antibiotic Prophylaxis

Administer prophylactic antibiotics for all possum bites, particularly hand wounds, puncture wounds, or any "dirty" wounds, as these carry high infection risk 3, 4:

• First-line: Amoxicillin-clavulanate (covers typical wound pathogens and anaerobes) 2, 1, 4
• Penicillin-allergic patients: Doxycycline, or fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin) plus metronidazole or clindamycin 2
• Intravenous therapy (for severe infections): Ampicillin-sulbactam, piperacillin-tazobactam, or carbapenems 2, 1
• Hand wounds or wounds near joints/bones require prophylactic antibiotics due to high risk of septic arthritis and osteomyelitis 1, 5
• Standard treatment duration is 7-10 days for uncomplicated wound infections 1

Tetanus Prophylaxis

• Administer tetanus toxoid (0.5 mL intramuscularly) if vaccination status is outdated or unknown 2, 1, 3
• For dirty wounds, give a booster if more than 5 years since last dose; for clean wounds, if more than 10 years 1

Rabies Risk Assessment

Rabies prophylaxis for possum bites requires careful consideration, as opossums (unlike rats and other small rodents) can carry rabies 3:

• Consult local health departments immediately to assess regional rabies prevalence in opossums 1
• If the possum cannot be captured and tested, or if rabies risk is present in your region, administer rabies immune globulin and vaccine series (days 0,3,7,14, and 28) for previously unvaccinated persons 2
• This differs from rat bites, where rabies prophylaxis is rarely needed in the United States 1

Special Considerations

• Hand wounds require expert evaluation for potential penetration into synovium, joint capsule, or bone, which increases risk of septic arthritis and osteomyelitis 2, 1
• Document neurovascular function (pulses, sensation) and range of motion of adjacent joints 4
• Follow up within 24 hours by phone or office visit for all outpatients 2, 1
• Hospitalize if infection progresses despite appropriate antibiotics, deep tissue involvement is suspected, or the patient is immunocompromised 1
• For complicated infections: treat osteomyelitis for 4-6 weeks and septic arthritis for 3-4 weeks 2, 1

Common Pitfalls

• Failing to irrigate adequately—mechanical irrigation is more important than antibiotic choice 1, 6
• Closing puncture wounds or infected wounds, which traps bacteria and increases infection risk 2, 1
• Assuming rabies prophylaxis is unnecessary without consulting local health authorities about regional possum rabies prevalence 3
• Underestimating hand wound severity—these always warrant prophylactic antibiotics and close follow-up 1, 5