Mammalian Bites Author: Jeffrey D. Kravetz, MD; Daniel G. Federman, MD
Editorial changes - 2008-01-23
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Drug Therapy
  • Consider antibiotic prophylaxis for certain mammalian bite wounds.
  • Provide appropriate antimicrobial therapy for infected dog bite wounds.
  • Provide appropriate antibiotics for infected cat bites.
  • Provide appropriate antimicrobial therapy for infected human bites.
  • Recognize that human bite wounds rarely transmit certain viral infections.
Drug Treatment for Mammalian Bites (table)

Consider antibiotic prophylaxis for certain mammalian bite wounds. A

  • Consider prophylactic antibiotics for patients with bite wounds less than 24 hours old:
    • Full-thickness cat-bite wounds presenting within 24 hours of injury
    • All mammalian hand bites and puncture wounds
    • High-risk dog bites only
  • Choose appropriate prophylactic antibiotics based on the microbiology of the biting animal's oral flora and treat for 3 to 5 days if no infection develops.
  • Consider amoxicillin-clavulanate as appropriate prophylactic therapy for dog, cat, and human bites.
  • See table Drug Treatment for Mammalian Bites.
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Provide appropriate antimicrobial therapy for infected dog bite wounds. B

  • Treat infected dog bite wounds with antibiotics for 10 to 14 days.
  • Treat patients who meet criteria for hospitalization with intravenous antibiotics.
  • Consider providing one dose of an intravenous antibiotic for patients who will be treated as outpatients with oral antibiotics.
  • Use either oral amoxicillin-clavulanate or intravenous ampicillin-sulbactam as first-line therapy against infected dog bites.
  • Consider azithromycin, a tetracycline, or a second- or third-generation cephalosporin with anaerobic coverage such as cefotaxime or cefoxitin as alternative monotherapies; newer fluoroquinolones, such as moxifloxacin, levofloxacin, or gatifloxacin can also be used as monotherapy.
  • Consider clindamycin with a fluoroquinolone or dicloxacillin with penicillin as alternative combination therapies if monotherapy is not available or the patient is intolerant to monotherapy.
  • Do not treat bite wound infections with penicillin, a first generation cephalosporin, an antistaphylococcal penicillin, clindamycin, or erythromycin alone.
  • Do not use co-trimoxazole or antipseudomonal aminoglycosides as therapy for patients at risk for sepsis from Capnocytophaga canimorsus.
  • See table Drug Treatment for Mammalian Bites.
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Provide appropriate antibiotics for infected cat bites. B

  • Treat infected cat bite wounds with antibiotics for 10 to 14 days.
  • Treat patients who meet criteria for hospitalization with iv antibiotics.
  • Consider providing one dose of an iv antibiotic for patients who will be treated as outpatients with oral antibiotics.
  • Use either oral amoxicillin-clavulanate or iv ampicillin-sulbactam as first-line therapy against infected cat bites.
  • Consider a second- or third-generation cephalosporin with anaerobic coverage, tetracycline, azithromycin, or a newer fluoroquinolone such as moxifloxacin or levofloxacin as alternative monotherapies.
  • Consider fluoroquinolone with clindamycin, penicillin with dicloxacillin, or co-trimoxazole with clindamycin as alternative combination therapies.
  • Do not treat bite wound infections with a first-generation cephalosporin, an antistaphylococcal penicillin, clindamycin, or erythromycin alone.
  • See table Drug Treatment for Mammalian Bites.
Background | Back to top


Provide appropriate antimicrobial therapy for infected human bites. B

  • Hospitalize patients with infected human hand bites for appropriate debridement, wound care, and intravenous antibiotics.
  • Consider hospitalization for intravenous antibiotics in all infected human bite wounds.
  • Treat infected human bites for 10 to 14 days.
  • Consider either oral amoxicillin-clavulanate or intravenous ampicillin-sulbactam as first-line therapy against infected human bites.
  • Consider second-generation cephalosporin with anaerobic coverage (cefotetan, cefoxitin), ticarcillin-clavulanate, or piperacillin-tazobactam as alternative monotherapies; newer fluoroquinolones (levofloxacin, moxifloxacin, gatifloxacin) may also be used in human bite infections.
  • Consider penicillin with an antistaphylococcal penicillin or clindamycin with a fluoroquinolone as alternative combination therapies.
  • Do not treat infected human bites with penicillin, antistaphylococcal penicillins, first-generation cephalosporins, ciprofloxacin, clindamycin, or erythromycin alone.
  • See table Drug Treatment for Mammalian Bites.
Background | Back to top


Recognize that human bite wounds rarely transmit certain viral infections. B

  • Consider antiretroviral prophylaxis with highly active antiretroviral therapy in patients with bite wounds inflicted by HIV-infected individuals with high viral loads.
  • Consider administration of HBIG and initiation of hepatitis B vaccination in patients bitten by an individual with hepatitis B infection.
  • Recognize that HCV can be transmitted by human bites.
  • See table Drug Treatment for Mammalian Bites.
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FAQs
Daniel G. Federman, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Jeffrey D. Kravetz, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Deborah Korenstein, MD, FACP, Co-Editor, PIER, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Richard B. Lynn, MD, FACP, Co-Editor, PIER, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.

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