Management of Human Bite Wounds
All human bite wounds require immediate prophylactic antibiotics with amoxicillin-clavulanate, regardless of wound appearance, because these injuries carry exceptionally high infection risk (20-25%) from polymicrobial oral flora and are frequently more serious than animal bites. 1
Immediate Antibiotic Prophylaxis
Start amoxicillin-clavulanate 875/125 mg twice daily immediately as the first-line agent, providing comprehensive coverage against the polymicrobial flora including beta-lactamase-producing anaerobes, streptococci (isolated from 50% of wounds), staphylococci (40%), Eikenella corrodens (30%), and anaerobes (Fusobacterium, Prevotella, Bacteroides, Porphyromonas). 2, 1
Do not delay antibiotic administration—prophylaxis must begin immediately upon presentation, as early administration prevents infection from high-risk human bites, particularly to the hand. 1
Alternative oral regimens for penicillin-allergic patients include doxycycline, moxifloxacin as monotherapy, or clindamycin plus a fluoroquinolone. 1
Wound Management Algorithm
Do not close human bite wounds except on the face, as closure dramatically increases risk of abscess formation. 2, 1
Irrigate thoroughly with copious amounts of sterile saline or running tap water (equally effective) until no debris remains—avoid povidone-iodine solutions which provide no benefit. 1
Debride necrotic tissue cautiously to avoid enlarging the wound and impairing potential closure. 1
Facial wounds may be closed primarily after meticulous debridement with prophylactic antibiotics, as cosmetic concerns outweigh infection risk in this location. 1
Cover clean wounds with an occlusive dressing; antibiotic dressings offer no additional benefit. 1
High-Risk Wounds Requiring Aggressive Management
Hand wounds and clenched-fist injuries over metacarpophalangeal joints are particularly dangerous and often require immediate hand specialist evaluation, surgical intervention, hospitalization, and intravenous antibiotics due to potential joint penetration, septic arthritis, or osteomyelitis. 1, 3
Wounds near joints or bones require prophylactic antibiotics due to high risk of septic arthritis or osteomyelitis. 1
Intravenous options for severe infections include piperacillin-tazobactam, carbapenems (ertapenem, imipenem, meropenem), cefoxitin, or ceftriaxone plus metronidazole. 1
Treatment Duration Based on Infection Severity
- Uncomplicated infections: 7-10 days of oral therapy 1
- Septic arthritis: 3-4 weeks of therapy 1
- Osteomyelitis: 4-6 weeks of therapy 1
Essential Adjunctive Measures
Administer tetanus toxoid 0.5 mL intramuscularly if vaccination is outdated (>10 years for clean wounds, >5 years for contaminated wounds) or unknown. 1
Consider post-exposure prophylaxis for hepatitis B, hepatitis C, and HIV transmission based on risk assessment in every case, as human bites can transmit these bloodborne pathogens. 2, 1
Mandatory Follow-Up
All outpatients require follow-up within 24 hours by phone or office visit to monitor for signs of infection. 1
Instruct patients to seek immediate care if redness, swelling, foul-smelling drainage, increased pain, or fever develops. 1
Critical Pitfalls to Avoid
Never close human bite wounds outside the face—this dramatically increases infectious complications including abscess formation. 2, 1
Never delay evaluation of hand wounds or clenched-fist injuries, regardless of benign appearance, as these require expert assessment for joint or bone penetration. 1
Do not use first-generation cephalosporins, macrolides, or penicillinase-resistant penicillins alone, as they have poor activity against Eikenella corrodens and anaerobes commonly present in human bite wounds. 1
Be aware that amoxicillin-clavulanate carries risks of hypersensitivity reactions (more likely with penicillin allergy history), hepatic dysfunction requiring monitoring in patients with liver impairment, and Clostridium difficile-associated diarrhea. 4