Mammalian bites: Difference between revisions
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===[[Antibiotics]]=== | ===[[Antibiotics]]=== | ||
*Consider for high-risk wounds (see above) | *Consider for high-risk wounds (see above) | ||
*[[Amoxicillin/Clavulanate|Amoxicilin-clavulanate]] 875mg PO BID x 5-7d<ref>Griego RD, Rosen T, Orengo IF, Wolf JE. Dog, cat, and human bites: a review. J Am Acad Dermatol. 1995;33:1019–29.</ref> | *[[Amoxicillin/Clavulanate|Amoxicilin-clavulanate]] 875mg PO BID x 5-7d<ref>Griego RD, Rosen T, Orengo IF, Wolf JE. Dog, cat, and human bites: a review. J Am Acad Dermatol. 1995;33:1019–29.</ref> | ||
*[[Doxycycline]] 100mg daily x 14 days if penicillin allergic <ref>Talan DA, Citron DM, Abrahamian FM, Moran GJ, Goldstein EJ. Bacteriologic analysis of infected dog and cat bites. Emergency Medicine Animal Bite Infection Study Group. N Engl J Med. 1999;340:85–92.</ref> | *[[Doxycycline]] 100mg daily x 14 days if penicillin allergic <ref>Talan DA, Citron DM, Abrahamian FM, Moran GJ, Goldstein EJ. Bacteriologic analysis of infected dog and cat bites. Emergency Medicine Animal Bite Infection Study Group. N Engl J Med. 1999;340:85–92.</ref> | ||
===[[Rabies]] prophylaxis=== | |||
*[[Rabies]] immune globulin should be inidividualized<ref>Human rabies—Washington, D.C., 1995. MMWR Morb Mortal Wkly Rep. 1995;44:625–7.</ref> | *[[Rabies]] immune globulin should be inidividualized<ref>Human rabies—Washington, D.C., 1995. MMWR Morb Mortal Wkly Rep. 1995;44:625–7.</ref> | ||
**Indicated for bites from bats, monkeys, skunks, raccoons, foxes. In the U.S. rare for dog and cat bites | **Indicated for bites from bats, monkeys, skunks, raccoons, foxes. In the U.S. rare for dog and cat bites | ||
Revision as of 23:50, 11 March 2015
Background
- 5% of untreated dog bites will become infected (similar to rate of non-bite wounds)
- 80% of untreated cat bites will become infected
- Human Bite: Closed fist infection
High-Risk Wounds
- Cat, human, livestock, or monkey bites
- Deep puncture wounds
- Hand or foot wounds
- Bites in immunosuppressed patients
Clinical Presentation
Workup
- Normally clinical diagnosis (no workup)
- Consider xray if possible retained tooth
Differential Diagnosis
Envenomations, bites and stings
- Hymenoptera stings (bees, wasps, ants)
- Mammalian bites
- Closed fist infection (Fight bite)
- Dog bite
- Marine toxins and envenomations
- Toxins (ciguatera, neurotoxic shellfish poisoning, paralytic shellfish poisoning, scombroid, tetrodotoxin
- Stingers (stingray injury)
- Venomous fish (catfish, zebrafish, scorpion fish, stonefish, cone shells, lionfish, sea urchins)
- Nematocysts (coral reef, fire coral, box jellyfish, sea wasp, portuguese man-of-war, sea anemones)
- Phylum porifera (sponges)
- Bites (alligator/crocodile, octopus, shark)
- Scorpion envenomation
- Reptile envenomation
- Spider bites
Treatment
Indications for Primary Closure of Mammalian Bites
- Consider closure if all of the following are true:
- Not a face or scalp wound
- Repair can occur within 6hr of injury (time dependent upon individual judgment)
- Repair only requires single-layer closure; no devitalized tissue
- No underlying fracture
- No systemic immunocompromising conditions
Antibiotics
- Consider for high-risk wounds (see above)
- Amoxicilin-clavulanate 875mg PO BID x 5-7d[1]
- Doxycycline 100mg daily x 14 days if penicillin allergic [2]
Rabies prophylaxis
- Rabies immune globulin should be inidividualized[3]
- Indicated for bites from bats, monkeys, skunks, raccoons, foxes. In the U.S. rare for dog and cat bites
See Also
Sources
- ↑ Griego RD, Rosen T, Orengo IF, Wolf JE. Dog, cat, and human bites: a review. J Am Acad Dermatol. 1995;33:1019–29.
- ↑ Talan DA, Citron DM, Abrahamian FM, Moran GJ, Goldstein EJ. Bacteriologic analysis of infected dog and cat bites. Emergency Medicine Animal Bite Infection Study Group. N Engl J Med. 1999;340:85–92.
- ↑ Human rabies—Washington, D.C., 1995. MMWR Morb Mortal Wkly Rep. 1995;44:625–7.