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- Provide adequate initial emergency treatment of bite wounds to decrease the risk of infection and increase the rate of functional recovery.
- Provide appropriate wound closure of mammalian bite wounds depending on the type of bite.
- Assess the patient's immune status and administer appropriate tetanus vaccination.
- Assess the risk of rabies transmission from dog and cat bites and provide appropriate therapy to prevent infection.
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Provide adequate initial emergency treatment of bite wounds to decrease the risk of infection and increase the rate of functional recovery.  |
- Irrigate all bite wounds aggressively with normal saline using an 18- or 19-gauge needle or plastic catheter.
- Consider irrigation with an antibacterial and antiviral solution such as 1% benzalkonium chloride in cases where rabies transmission is considered possible.
- Thoroughly cleanse wounds with tap water if antibacterial and antiviral solutions are not available in cases in which rabies transmission is possible.
- Debride all devitalized tissue in the vicinity of a bite wound.
- Consider surgical consultation for exploration and debridement of wounds near joints, on the hand, or in the head and neck area.
- Elevate extremity bite wounds by using a sling for hand bites and advising bed rest with leg elevation for lower extremity bites.
- In patients with infected hand bites, immobilize the bitten hand in the position of function and start early physical therapy (within 3 to 5 days).
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Provide appropriate wound closure of mammalian bite wounds depending on the type of bite.  |
- Always allow infected bite wounds to heal by secondary intention.
- Consider allowing the following bite wounds to heal by secondary intention:
- Deep puncture wounds
- Bite wounds over 24 hours old
- Extremity bites
- Consider primary closure of facial lacerations resulting from human and dog bites.
- Consider primary closure of low-risk bite wound lacerations, defined as noninfected wounds without evidence of damage to underlying structures, presenting within 24 hours of injury.
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Assess the patient's immune status and administer appropriate tetanus vaccination.  |
- Administer tetanus vaccination (tetanus and diphtheria toxoids) to patients with clean, minor wounds if:
- Their tetanus immune status is unknown
- They have not completed the primary vaccination series, or
- More than 10 years has elapsed since their last vaccination
- In patients with puncture wounds or visibly contaminated wounds, administer both tetanus immunization and tetanus immune globulin if:
- Their immune status is unknown
- They have not completed the primary vaccination series
- In patients with puncture wounds or visibly contaminated wounds who have been vaccinated previously, administer a booster tetanus toxoid if more than 5 years has elapsed since the last vaccination.
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Assess the risk of rabies transmission from dog and cat bites and provide appropriate therapy to prevent infection. |
- Clean high-risk dog and cat bite wounds with an antibacterial or antiviral solution, such as benzalkonium chloride or soap.
- Thoroughly cleanse wounds with tap water if antibacterial and antiviral solutions are not available in bites where rabies transmission is possible.
- Consider rabies preexposure prophylaxis in travelers who will be in countries endemic for animal rabies if access to medical care is limited.
- Consider bite wounds from dogs in developing countries to be at high risk for rabies transmission.
- Recognize that unprovoked bites may indicate that the biting animal is rabid.
- Administer both rabies vaccine and rabies immune globulin in separate syringes to previously unvaccinated individuals with high-risk dog or cat bite exposures involving animals with known or suspected rabies.
- Administer only rabies vaccine to previously vaccinated individuals with high-risk dog or cat bite exposures involving animals with known or suspected rabies.
- If the dog or cat inflicting the bite is healthy and available for observation, observe the animal for 10 days and administer rabies vaccine and immune globulin if signs of rabies develop.
- Euthanize dogs or cats who develop signs of rabies immediately and arrange for evaluation of their brain for rabies virus by a qualified laboratory.
- Consider immediate rabies vaccination of individuals with head and neck bite wounds inflicted by a dog or cat with an unknown vaccination status.
- Consider vaccination of patients with bite wounds inflicted by animals that have escaped and consult public health officials to assess the local risk of rabies transmission.
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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.
Steven E. Weinberger, MD, FACP, Acting Editor, PIER, has stock holdings in Glaxosmithkline and Abbott. |
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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
compare the date of the last update on the website with any printout
to ensure that the information being referred to is the most current
available.
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PIER is copyrighted (c) 2009 by the American College of Physicians,
190 N. Independence Mall West, Philadelphia, PA 19106-1572, USA.
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Mammalian Bites
