From the Guidelines
Human bites should be treated with amoxicillin-clavulanate (Augmentin) at 875/125 mg twice daily for 5-7 days, as it is the first-line antibiotic that covers both aerobic and anaerobic bacteria commonly found in the human mouth. This recommendation is based on the guidelines for the diagnosis and management of skin and soft tissue infections, which suggest that amoxicillin-clavulanate is effective against a wide range of bacteria, including Streptococcus, Staphylococcus, Eikenella, and anaerobes 1. For penicillin-allergic patients, alternatives include clindamycin (300-450 mg four times daily) plus either ciprofloxacin (500 mg twice daily) or trimethoprim-sulfamethoxazole (one double-strength tablet twice daily) 1.
Some key points to consider when treating human bites include:
- The diverse oral flora, which includes Streptococcus, Staphylococcus, Eikenella, and anaerobes, and requires broad-spectrum antibiotic coverage 1
- The importance of proper wound care, including thorough cleaning with soap and water, irrigation with sterile saline, removal of any foreign material, and consideration of tetanus prophylaxis if needed 1
- The need for prompt antibiotic treatment to prevent infection, especially in deep or facial bites, immunocompromised patients, or bites with signs of infection (redness, swelling, warmth, pus) 1
- The potential for more aggressive treatment, including possible hospitalization for intravenous antibiotics, in severe cases 1
It is essential to note that the bacteriology of human bite wounds can be complex, and empirical therapy might miss certain pathogens 1. Therefore, it is crucial to consider the specific circumstances of each case and adjust treatment accordingly. Additionally, cultures are often not done on wounds, and empirical therapy might require broader coverage for abscesses or more focused therapy for nonpurulent infected wounds 1.
From the Research
Human Bite Antibiotics
- The use of antibiotics for human bites is a common practice, but the choice of antibiotic depends on various factors, including the severity of the bite and the patient's medical history 2.
- Amoxicillin and amoxicillin-clavulanic acid are widely used antibiotics for treating human bites, but they have different antibacterial activities and safety profiles 3, 4.
- Amoxicillin-clavulanic acid is often used as empiric therapy for various infections, including those caused by bacteria that can be found in human bites, but it may not always be the best choice due to its potential side effects and contribution to antibiotic resistance 4.
- Other antibiotics, such as cephalosporins, may also be effective against bacteria that can cause infections in human bites, and their use should be considered based on the specific circumstances of the bite and the patient's needs 5.
Antibiotic Options
- Amoxicillin: a widely used antibiotic that is effective against many types of bacteria, but may not be effective against bacteria that produce beta-lactamases 3, 4.
- Amoxicillin-clavulanic acid: a combination antibiotic that is effective against a broader range of bacteria than amoxicillin alone, but may have more side effects and contribute to antibiotic resistance 3, 4.
- Cephalosporins: a class of antibiotics that includes cefaclor, cefdinir, cefpodoxime, cefprozil, and cefuroxime axetil, which may be effective against bacteria that can cause infections in human bites 5.
Considerations for Antibiotic Use
- The use of antibiotics for human bites should be guided by evidence-based practice guidelines and should take into account the severity of the bite, the patient's medical history, and the potential risks and benefits of antibiotic treatment 2.
- The choice of antibiotic should be based on the specific circumstances of the bite and the patient's needs, and should consider factors such as the type of bacteria that may be present, the patient's allergy history, and the potential for antibiotic resistance 3, 4, 5.