Rationale:

• Human bite wounds are usually closed fist injuries, which on extension of the fist retract proximally the bacteria inoculated into the bite site. These injuires have a high rate of infection.
• Cat bites usually result in deep puncture wounds rather than laceration, causing a high rate of infection.
• Antibiotic prophylaxis reduces the likelihood of infection of certain types of bite wounds.
• Rabies is fatal once symptoms appear. Prophylaxis with rabies immune globulin and vaccine is highly effective.

Evidence:

• A Cochrane review found some evidence that antibiotic prophylaxis following bites of the hand can reduce infection, but more research is needed (15).
• A multicenter prospective study of 50 patients with infected human bites found amoxicillin-clavulanic acid and moxifloxacin to have excellent in-vitro activity against common isolates (16).
• A prospective study at 18 emergency departments to better define the bacteria causing infections of dog and cat bites concluded that infected dog and cat bites have a complex microbiologic mix that includes pasteurella species but also other organisms that were not previously identified as bite-wound pathogens (17).
• The Infectious Diseases Society of America has published guidelines for the diagnosis and management of skin and soft-tissue infections (18).

Comments:

• None.