Do I need to prescribe antibiotics for a superficial bite from a common house gecko in an otherwise healthy patient?

No Antibiotics Needed for Superficial Gecko Bites in Healthy Patients

For a superficial bite from a common house gecko in an otherwise healthy patient, antibiotics are not indicated. Gecko bites are non-venomous, carry minimal infection risk, and should be managed with local wound care alone.

Rationale for No Antibiotic Therapy

Wound Classification and Risk Assessment

• Gecko bites are superficial wounds from a non-mammalian source with extremely low bacterial load compared to mammalian bites 1
• Superficial wounds without signs of infection (erythema <5 cm, temperature <38.5°C, WBC <12,000 cells/µL, pulse <100 bpm) do not require antibiotics 2
• The evidence supporting antibiotic prophylaxis is specific to mammalian bites (human, dog, cat) where polymicrobial oral flora poses significant infection risk 1, 3

Evidence Against Routine Prophylaxis

• Even for mammalian bites, prophylactic antibiotics show no benefit for dog or cat bites in general populations 3
• Antibiotics are only indicated for mammalian bites when specific high-risk features are present: hand location, deep puncture wounds, immunocompromised hosts, or presentation with existing infection 1, 3
• Studies on reptilian bites (rattlesnakes) demonstrate infection rates <1% without prophylactic antibiotics, with isolated bacteria typically of human skin origin rather than reptilian 4

Appropriate Management

Immediate Wound Care

• Irrigate the wound thoroughly with copious running tap water or sterile normal saline until all visible debris is removed 1
• Running tap water is as effective as sterile saline and superior to antiseptic solutions like povidone-iodine 1
• Remove only superficial debris; avoid aggressive debridement 1

Tetanus Prophylaxis

• Verify tetanus immunization status and administer tetanus toxoid (0.5 mL IM) if the last dose was >5 years ago or status is unknown 1, 5
• If immunization history is incomplete or unknown, administer both tetanus toxoid and tetanus immune globulin at separate sites 1

Wound Closure Decision

• Do not close gecko bite wounds with sutures; allow healing by secondary intention 1
• Approximation with adhesive strips (Steri-Strips) is acceptable for non-infected wounds if needed 1

Follow-Up

• Instruct the patient to monitor for signs of infection: increasing pain, redness, swelling, warmth, purulent drainage, or fever 1
• Arrange follow-up within 24-48 hours if any concerns arise 1
• Return immediately if systemic symptoms develop 1

When Antibiotics WOULD Be Indicated

Signs Requiring Antibiotic Therapy

• Temperature >38.5°C or heart rate >110 bpm 2
• Erythema extending >5 cm beyond wound margins 2
• Purulent drainage, warmth, or other signs of established infection 2
• Immunocompromised status or presence of implanted devices 1

First-Line Antibiotic Choice (If Needed)

• Amoxicillin-clavulanate is first-line for infected mammalian bite wounds 1, 5
• For penicillin allergy: doxycycline 100 mg twice daily 1, 5
• Duration: 3-5 days for prophylaxis, longer for established infection 1

Critical Pitfalls to Avoid

• Do not prescribe antibiotics for clean, superficial wounds without infection signs—this promotes unnecessary antibiotic resistance and expense 2, 4, 6
• Do not use antiseptic solutions for irrigation—water or saline is superior 1
• Do not close the wound if any signs of infection are present 1
• Do not overlook tetanus status—this is the primary infectious concern in clean animal wounds 1, 5