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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)
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Consider antibiotic prophylaxis for certain mammalian bite wounds.  |
- 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.
| Background | Back to top
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Provide appropriate antimicrobial therapy for infected dog bite wounds.  |
- 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.
| Background | Back to top
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Provide appropriate antibiotics for infected cat bites. |
- 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
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Provide appropriate antimicrobial therapy for infected human bites. |
- 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
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Recognize that human bite wounds rarely transmit certain viral infections. |
- 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.
| Background | Back to top
| | | FAQs |
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| 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. |
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The information included herein should never be used as a substitute
for clinical judgment and does not represent an official position of
ACP. Because all PIER modules are updated regularly, printed web pages
or PDFs may rapidly become obsolete. Therefore, PIER users should
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PIER is copyrighted (c) 2008 by the American College of Physicians,
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Mammalian Bites
