Management of Human Bite Wounds
All human bite wounds should be evaluated in a medical facility as soon as possible due to high infection risk from polymicrobial oral flora. 1
Immediate Wound Care
Irrigation and Cleaning
- Thoroughly irrigate the wound until no obvious debris or foreign matter remains, using copious amounts of running tap water or sterile saline solution rather than antiseptic agents like povidone-iodine. 1
- Irrigation with tap water is as effective as sterile saline and avoids the lack of benefit seen with povidone-iodine solutions. 1
- Remove only superficial debris; avoid aggressive debridement that may enlarge the wound unnecessarily. 2
Tetanus Prophylaxis
- Administer tetanus toxoid 0.5 mL intramuscularly if vaccination status is outdated or unknown. 2
- For contaminated wounds, give a booster if more than 5 years since last dose; for clean wounds, if more than 10 years since last dose. 2
Wound Closure Decisions
General Approach
- Do not close infected wounds or most human bite wounds, as closure increases risk of abscess formation. 3, 2
- For clean wounds seen early, approximate with Steri-Strips rather than sutures if closure is considered. 2
Facial Wounds Exception
- Facial wounds may be closed primarily after meticulous debridement and with prophylactic antibiotics, as cosmetic concerns outweigh infection risk in this location. 2, 4, 5
- Studies show 90% complete healing with immediate closure of facial human bites, even when presenting 1-4 days after injury. 4
Antibiotic Management
High-Risk Wounds Requiring Prophylaxis
- Hand wounds or wounds near joints/bones require prophylactic antibiotics due to high infection risk and potential for septic arthritis or osteomyelitis. 2
- Early antibiotic administration prevents infection from high-risk human bites to the hand. 1
- Deep wounds, wounds in critical areas, immunocompromised patients, and those with severe comorbidities warrant prophylaxis. 3
Antibiotic Selection
- Amoxicillin-clavulanate is first-line therapy, providing coverage for polymicrobial oral flora including beta-lactamase-producing organisms and Eikenella corrodens. 2, 6, 5
- Alternative oral options include cephalosporins, penicillinase-resistant penicillins, doxycycline, or fluoroquinolones. 2
- For severe infections requiring hospitalization, use intravenous ampicillin-sulbactam, piperacillin-tazobactam, second-generation cephalosporins, or carbapenems. 2
Treatment Duration
Post-Wound Care
Dressing Application
- Cover clean wounds with an occlusive dressing (film, petrolatum, hydrogel, or cellulose/collagen) to promote healing; antibiotic dressings offer no additional benefit for clean wounds. 1
- Elevate injured extremities to reduce swelling. 2
Monitoring for Infection
- Remove dressing and obtain medical care if redness, swelling, foul-smelling drainage, increased pain, or fever develops. 1, 3
- Systemic symptoms (fever, chills, lymphadenopathy) require immediate medical attention. 3
Special Considerations
Clenched Fist Injuries
- These "fight bites" over the metacarpophalangeal joints are particularly dangerous and often require surgical evaluation, hospitalization, and intravenous antibiotics due to potential joint penetration. 2, 6
Follow-Up
- All outpatients require follow-up within 24 hours by phone or office visit. 2
- Hospitalization is indicated if infection progresses despite appropriate antibiotics, deep tissue involvement is suspected, or the patient is immunocompromised. 2
Common Pitfalls to Avoid
- Do not underestimate human bites—they carry 10% infection risk with polymicrobial organisms from oral flora. 7, 6
- Do not routinely close human bite wounds outside the face, as this dramatically increases infection complications. 3, 2
- Do not delay evaluation of hand wounds, as these require expert assessment for joint or bone penetration. 2