Management of Human Bite Wounds
All human bite wounds should be evaluated in a medical facility as soon as possible due to their high infection risk (20-25% infection rate) from polymicrobial oral flora, and prophylactic antibiotics with amoxicillin-clavulanate should be administered for high-risk wounds, particularly those involving the hand, near joints, or presenting within 24 hours of injury. 1, 2
Immediate Wound Assessment and Care
Initial Evaluation
- Thoroughly irrigate the wound with copious amounts of running tap water or sterile saline until no debris or foreign matter remains 1, 2
- Tap water is equally effective as sterile saline and superior to povidone-iodine solutions, which provide no additional benefit 1
- Avoid high-pressure irrigation as this may drive bacteria deeper into tissue layers 1
- Perform careful debridement of necrotic tissue only—avoid aggressive debridement that enlarges the wound 1
Critical Red Flags Requiring Immediate Attention
- Clenched-fist injuries over metacarpophalangeal joints are surgical emergencies requiring expert evaluation for joint penetration, often necessitating hospitalization and IV antibiotics 1, 2
- Pain disproportionate to injury near bone or joint suggests periosteal penetration and potential septic arthritis or osteomyelitis 1
- Hand wounds are inherently more serious than wounds to fleshy body parts due to proximity to joints, tendons, and bones 1
Wound Closure Decision Algorithm
Do not close human bite wounds except in specific circumstances: 1, 2
- Never close infected wounds 1
- Never close most human bite wounds as closure dramatically increases abscess formation risk 1, 2
- Exception: Facial wounds may be closed primarily after meticulous debridement, copious irrigation, and with prophylactic antibiotics, as cosmetic concerns outweigh infection risk in this location 1, 2
- For non-facial wounds presenting <8 hours post-injury, consider approximation with Steri-Strips followed by delayed primary or secondary closure 1
Antibiotic Management Strategy
Indications for Prophylactic Antibiotics
Administer prophylactic antibiotics for: 1, 2, 3
- All hand wounds (highest priority—infection prevention demonstrated in randomized trials) 2, 3
- Wounds near joints or bones 1, 2
- Deep wounds 1
- Facial or genital wounds 1
- Fresh wounds presenting within 24 hours 1
- Patients with compromised immune status or severe comorbidities 1
Do NOT give antibiotics if: 1
- Patient presents ≥24 hours after bite with no clinical signs of infection 1
First-Line Antibiotic Choice
Amoxicillin-clavulanate is the recommended first-line oral agent providing coverage for polymicrobial oral flora including beta-lactamase-producing organisms, Eikenella corrodens (present in 30% of human bites), Streptococcus species (50%), and Staphylococcus aureus (40%) 1, 2, 4
Alternative Oral Regimens
If amoxicillin-clavulanate is contraindicated: 1
- Doxycycline
- Penicillin VK plus dicloxacillin
- Fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin) PLUS metronidazole or clindamycin for anaerobic coverage
Avoid these agents (poor activity against E. corrodens): 1
- First-generation cephalosporins (cephalexin)
- Penicillinase-resistant penicillins alone (dicloxacillin)
- Macrolides (erythromycin)
- Clindamycin alone
Intravenous Options for Severe Infections
For hospitalized patients or severe infections: 1
- Ampicillin-sulbactam
- Piperacillin-tazobactam
- Second-generation cephalosporins (cefoxitin)
- Carbapenems (ertapenem, imipenem, meropenem)
Duration of Therapy
- Prophylaxis: 3-5 days for uncomplicated wounds 1
- Septic arthritis: 3-4 weeks 1
- Osteomyelitis: 4-6 weeks 1
Tetanus Prophylaxis
Administer tetanus toxoid 0.5 mL intramuscularly if: 1, 2
- Vaccination status is outdated (>5 years for contaminated wounds, >10 years for clean wounds)
- Status is unknown
Bloodborne Pathogen Risk Assessment
Human bites can transmit HBV, HCV, and HIV 1
- Post-exposure prophylaxis should be considered in every case 1
- Obtain baseline serology when indicated 5
- Assess viral status of biter when possible 5
Post-Wound Care and Follow-Up
Dressing Management
- Cover clean wounds with occlusive dressings (film, petrolatum, hydrogel) to promote healing 1, 2
- Antibiotic dressings offer no additional benefit for clean wounds 1, 2
- Elevate injured body part, especially if swollen, to accelerate healing 1
Mandatory Follow-Up
All outpatients require follow-up within 24 hours by phone or office visit 1, 2
Warning Signs Requiring Immediate Re-Evaluation
Remove dressing and obtain medical care if: 1, 2
- Redness or swelling develops
- Foul-smelling wound drainage appears
- Pain increases
- Fever develops
Hospitalization Criteria
Consider hospitalization if: 1
- Infection progresses despite appropriate antimicrobial and ancillary therapy
- Deep infection with systemic signs
- Joint or bone involvement suspected
Common Pitfalls to Avoid
Do not routinely close human bite wounds outside the face—this dramatically increases infection complications including abscess formation 1, 2
Do not delay evaluation of hand wounds—these require expert assessment for joint or bone penetration, as delayed presentation (mean 2.5 days vs 0.5 days for superficial infections) is associated with 27% complication rate including stiffness and recurrent infection 2, 6
Do not rely on mechanical wound care alone—randomized trial showed 46.7% infection rate with placebo versus 0% with antibiotics 3
Do not use inadequate antibiotic coverage—avoid monotherapy with agents lacking anaerobic or E. corrodens coverage 1
Do not forget viral transmission risk—assess and document need for post-exposure prophylaxis 1