Pig Bite Management
Treat pig bites using the same evidence-based approach as other mammalian bites: immediate copious irrigation with sterile saline, amoxicillin-clavulanate as first-line antibiotic prophylaxis (especially for hand wounds, puncture wounds, or wounds near joints), tetanus prophylaxis, and wound closure decisions based on location and infection risk.
Immediate Wound Management
Irrigate the wound immediately and thoroughly with copious amounts of sterile normal saline or water using a 20-mL or larger syringe to generate adequate pressure and reduce bacterial load 1, 2, 3.
Remove only superficial debris during cleansing—avoid aggressive debridement that could unnecessarily enlarge the wound 2, 3.
Do not use iodine- or antibiotic-containing solutions for routine wound cleansing 1, 2, 3.
Explore the wound for potential tendon, bone, or joint involvement, particularly in hand injuries 4.
Antibiotic Prophylaxis and Treatment
Amoxicillin-clavulanate (875/125 mg twice daily) is the first-line antibiotic for pig bites, providing broad-spectrum coverage against typical mammalian oral flora and anaerobes 1, 2, 3.
Indications for Prophylactic Antibiotics:
- Hand wounds (high infection risk and potential for deep structure involvement) 2, 3
- Puncture wounds (difficult to irrigate adequately) 5, 4
- Wounds near joints or bones 2, 3
- "Dirty" wounds or those with tissue devitalization 5
- Immunocompromised patients 2
Alternative Antibiotic Options:
- For penicillin-allergic patients: Doxycycline 100 mg twice daily 1, 3
- For severe infections requiring IV therapy: Ampicillin-sulbactam, piperacillin-tazobactam, second-generation cephalosporins (cefoxitin), or carbapenems 1, 2, 3
- Avoid first-generation cephalosporins, macrolides, or clindamycin alone due to inadequate coverage 3
Treatment Duration:
- Prophylaxis: 3-5 days 3
- Established infection: 7-10 days 2, 3
- Septic arthritis: 3-4 weeks 1, 2, 3
- Osteomyelitis: 4-6 weeks 1, 2, 3
Wound Closure Decisions
Do not close infected wounds (those with purulent discharge, erythema, or established infection) 1, 2, 3.
For clean wounds seen early (<8 hours), consider approximation with Steri-Strips rather than sutures 1, 2, 3.
Facial wounds are the exception: These may be closed primarily after meticulous irrigation, debridement, and initiation of prophylactic antibiotics 1, 2, 3.
Consider delayed primary or secondary closure for non-facial wounds 2.
Tetanus Prophylaxis
Tetanus prophylaxis is mandatory for all pig bites 2, 3.
Administer tetanus toxoid 0.5 mL intramuscularly if vaccination status is outdated or unknown 1, 2, 3.
For dirty wounds (all pig bites qualify): Booster needed if >5 years since last dose 2, 3.
For clean wounds: Booster needed if >10 years since last dose 2, 3.
Rabies Prophylaxis
Rabies prophylaxis for pig bites requires consultation with local health departments for regional risk assessment, as domestic pigs are not typical rabies vectors 2, 3.
Consider prophylaxis only for feral or wild pig bites in high-prevalence areas 2, 3.
If indicated, administer both rabies immunoglobulin and vaccine series (days 0,3,7,14, and 28) to previously unvaccinated individuals 1, 3.
Special Considerations and Follow-Up
Hand wounds or wounds near joints require expert evaluation for potential penetration into synovium, joint capsule, or bone, as these carry higher risk of septic arthritis and osteomyelitis 1, 2.
Elevate the injured extremity to reduce swelling and accelerate healing 1, 2, 3.
Follow up within 24 hours by phone or office visit for all outpatients 1, 2, 3.
Monitor for signs of infection: increasing pain, redness, swelling, purulent discharge 3, 6.
Indications for Hospitalization:
- Infection progressing despite appropriate antimicrobial therapy 1, 2, 3
- Deep tissue involvement suspected 2, 3
- Immunocompromised status or significant comorbidities 2, 3
- Suspected septic arthritis or osteomyelitis 1, 7
Common Pitfalls to Avoid
Do not underestimate puncture wounds—these have high infection rates despite appearing minor 5, 4.
Hand wounds require aggressive management; failure to provide prophylactic antibiotics and early specialist consultation can lead to devastating complications 2, 3.
Avoid closing pig bite wounds outside the face, as this significantly increases infection risk 1, 2, 3.