What is the appropriate management for a bite from an American woodcock?

Management of American Woodcock Bite

Treat an American woodcock bite as you would any other bird bite: thoroughly irrigate the wound with copious amounts of water or saline, avoid primary closure except for facial wounds, ensure tetanus prophylaxis is current, and consider antibiotic prophylaxis for high-risk wounds (hand, deep punctures, or immunocompromised patients) using amoxicillin-clavulanate as first-line therapy. 1

Immediate Wound Care

• Irrigate the wound copiously with running tap water or sterile saline until all visible debris and foreign matter are removed 1
• Use a syringe capable of delivering at least 20 mL of fluid to create sufficient mechanical pressure for effective bacterial removal 2
• Continue irrigation until no foreign material is visible in the wound 1, 2
• Avoid high-pressure irrigation as it can drive bacteria deeper into tissue layers 1
• Remove only superficial debris; avoid aggressive debridement that could enlarge the wound or impair healing 1, 2

Wound Closure Decision

• Do not close the wound primarily unless it is on the face 1
• For non-facial wounds, approximate the edges with adhesive strips (Steri-Strips) to allow drainage and promote healing by secondary intention 1, 2
• Facial wounds may be closed primarily after meticulous irrigation and appropriate antibiotic prophylaxis because they have lower infection rates and better cosmetic outcomes 1, 2, 3
• Never close a wound that already exhibits signs of infection 1, 2

Antibiotic Prophylaxis

Consider prophylactic antibiotics for high-risk wounds, including:

• Deep puncture wounds 1
• Hand injuries (strongest evidence for benefit) 1, 2
• Wounds near joints, feet, face, or genitals 1
• Immunocompromised patients or those with implanted devices 1, 2

Do not administer antibiotics if the patient presents ≥24 hours after the bite with no signs of infection 1, 2

Antibiotic Selection

• First-line oral therapy: Amoxicillin-clavulanate 875/125 mg twice daily for 3-5 days 1, 2
• Penicillin allergy alternative: Doxycycline 100 mg orally twice daily 1, 2
• Other alternatives: Fluoroquinolones (ciprofloxacin, levofloxacin, or moxifloxacin) plus metronidazole 1, 2

Avoid first-generation cephalosporins, macrolides, and clindamycin alone as they lack activity against potential pathogens in bite wounds 2

Tetanus Prophylaxis

• Administer tetanus toxoid if the patient has not received vaccination within the past 10 years 1
• For dirty or contaminated wounds, give tetanus toxoid if >5 years have elapsed since the last dose 1
• Tdap is preferred over Td if the patient has not previously received Tdap 1, 2
• If immunization history is unknown or incomplete, administer both tetanus toxoid and tetanus immune globulin at separate anatomical sites 2

Supportive Care and Follow-Up

• Elevate the injured body part (use a sling for upper extremity injuries) to reduce edema and promote healing 1, 2
• Arrange follow-up within 24 hours (in-person or by telephone) to assess for early signs of infection 1, 2
• Instruct the patient to seek immediate care if they develop increasing pain, redness, swelling, warmth, fever, or systemic symptoms 1, 2

Critical Pitfalls to Avoid

• Do not use antiseptic solutions (e.g., povidone-iodine) for irrigation; water or saline is superior 1, 2
• Do not close infected wounds or wounds presenting late, as this traps bacteria and increases infection risk 1, 2
• Do not delay initial evaluation; early intervention is essential to prevent serious complications 2
• Do not apply ice directly to the wound as it can produce tissue ischemia 1

Special Considerations for Bird Bites

While the provided guidelines focus primarily on mammalian bites, the same general principles apply to bird bites including woodcock bites 1. Bird bites carry a lower risk of rabies transmission compared to mammalian bites, so rabies prophylaxis is typically not indicated 1. However, the wound should still be managed aggressively to prevent bacterial infection from the bird's oral flora 4.