What is the appropriate management for a patient with a human bite, considering potential underlying medical conditions such as diabetes or immunosuppression?

Management of Human Bites

All human bite wounds require immediate prophylactic antibiotics with amoxicillin-clavulanate, thorough irrigation without closure (except facial wounds), and urgent evaluation—particularly for hand injuries which demand specialist assessment within 24 hours. 1

Immediate Antibiotic Prophylaxis

• Start amoxicillin-clavulanate immediately for all human bite wounds, regardless of appearance, as these carry higher infection risk than animal bites due to polymicrobial oral flora. 1
• Amoxicillin-clavulanate provides comprehensive coverage against beta-lactamase-producing anaerobes, streptococci, staphylococci, Eikenella corrodens (present in 30% of cases), and other anaerobes (present in 60% of cases). 1, 2
• Prophylactic antibiotics prevent infection in early human bites—one randomized study showed 47% infection rate with placebo versus 0% with antibiotics. 3
• In immunosuppressed or diabetic patients, antibiotic prophylaxis is even more critical given their impaired wound healing and increased infection susceptibility. 1

Wound Care Protocol

• Irrigate thoroughly with copious amounts of running tap water or sterile saline until no debris remains—tap water is as effective as sterile saline. 1
• Avoid povidone-iodine solutions as they provide no additional benefit over saline irrigation. 1
• Perform cautious superficial debridement to remove obvious debris, but avoid aggressive deep debridement that enlarges the wound. 1

Wound Closure Decision Algorithm

• Do NOT close human bite wounds except on the face—closure dramatically increases abscess formation risk. 1
• Facial wounds may be closed primarily after meticulous debridement with prophylactic antibiotics, as cosmetic concerns outweigh infection risk in this location. 1
• Leave all other wounds open and cover with occlusive dressing; antibiotic dressings offer no additional benefit. 1

Hand Wounds: High-Risk Category

• All hand wounds require prophylactic antibiotics due to high risk of septic arthritis and osteomyelitis. 1
• Clenched-fist injuries over metacarpophalangeal joints require immediate hand specialist evaluation, hospitalization, and IV antibiotics regardless of benign appearance—these frequently penetrate joints. 1
• Hand bites have significantly higher complication rates than bites elsewhere, with 27% suffering stiffness, recurrent infection, or other complications when treatment is delayed. 4
• The mean delay in severely infected hand bites is 2.5 days versus 0.5 days for less severe infections—emphasizing the need for immediate evaluation. 4

Tetanus Prophylaxis

• Administer tetanus toxoid 0.5 mL IM if vaccination status is outdated or unknown. 1
• For contaminated wounds, give booster if >5 years since last dose; for clean wounds, if >10 years since last dose. 1

Infectious Disease Considerations in Special Populations

• Consider post-exposure prophylaxis for hepatitis B, hepatitis C, and HIV based on risk assessment—particularly important in immunosuppressed patients. 1
• Viral transmission through human bites is a real concern and should be addressed in the initial evaluation. 2

Treatment Duration for Established Infections

• Treat septic arthritis for 3-4 weeks. 1
• Treat osteomyelitis for 4-6 weeks. 1
• These extended durations are especially critical in diabetic and immunosuppressed patients who have impaired immune responses. 1

Follow-Up Requirements

• All outpatients require follow-up within 24 hours by phone or office visit. 1
• Instruct patients to return immediately if redness, swelling, foul-smelling drainage, increased pain, or fever develops. 1

Critical Pitfalls to Avoid

• Never delay antibiotic administration—prophylaxis must begin immediately, not after waiting to see if infection develops. 1
• Never close human bite wounds outside the face—this single error dramatically increases infectious complications. 1
• Never underestimate hand wounds—even small lacerations over joints can penetrate deeply and require specialist evaluation. 1
• Do not use penicillin or first-generation cephalosporins alone, as many oral anaerobes produce β-lactamases rendering these ineffective. 2