Management of Bite Wounds in the ED

by: Lynn Manganiello

Basics:

Wound care management including:

-Hemostasis

-Exploration for foreign bodies (ex teeth) - consider radiography or ultrasound if high suspicion

-Update tetanus if indicated

When to Close:

- Face or scalp involvement

- No devitalized tissue

- No underlying fracture

- Not immunocompromised

When to Prophylax:

- All cat, human, livestock, or monkey bites

- Puncture wound

- History of diabetes or immunocompromised

- Involvement of hand or foot, or face if primary closure

- Heavily contaminated wound or presence of devitalized tissue

-Usually 3-5 day course sufficient

-Consider parenteral antibiotics if established infection, especially involving hands

Specific Etiologies & Treatments:

Dog: Capnocytophaga canimorsus; also Pasturella multocida, Staph, Strep --> Augmentin

Cat: Pasturella multocida --> Augmentin

Bartonella henselae (cat scratch) --> Azithromycin

Human: Eikenella corrodens; Staph, Strep --> Augmentin

If penicillin allergic:

- Dog - clindamycin + fluoroquinolone​

- Cat - doxycycline or cefuroxime

Don't forget to assess rabies risk - highest risk if bat, skunk, raccoon, fox

Rarer infections:

Rodents or squirrels - Streptobacillus moniliformis

Livestock - Brucella, Leptospira, Francisella

Monkeys - Herpes B virus

Freshwater fish - Aeromonas, Staph, Strep

Saltwater fish - Vibrio, staph, strep

References:

Quinn, J. “Puncture Wounds and Bites.” Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8eEds. Judith E. Tintinalli, et al. New York, NY: McGraw-Hill, 2016.