Bites | Right Decisions

If there are signs of active infection e.g. cellulitis at bite injury site then 5 days antibiotic treatment should be offered.

If there are NO signs of active infection then use following table to assess requirement of 3 days antibiotic prophylaxis:

Bites from	No prophylaxis	Consider prophylaxis	Offer prophylaxis
Human	Hasn't broken skin	Hasn’t broken skin but: - high-risk area (hands, feet, face, genitals, skin overlying cartilaginous structures) or an area of poor circulation - Increased risk of infection (e.g. diabetes, immunosuppression, asplenia, decompensated liver disease)	Broken skin & drawn blood
Cat	Hasn't broken skin	Broken the skin but not drawn blood if the wound could be deep	- Broken skin & drawn blood
Dog or other traditional pet (excluding cat)	Hasn’t broken skin Broken skin but didn’t draw blood	Broken skin & drawn blood, if: - high-risk area (hands, feet, face, genitals, skin overlying cartilaginous structures) or an area of poor circulation - Increased risk of infection (e.g. diabetes, immunosuppression, asplenia, decompensated liver disease, prosthetic heart valve, or at the extremes of age	Broken skin & drawn blood, if: - Has penetrated bone, joint, tendon, or vascular structures. - Is deep, is a puncture or crush wound, or has caused significant tissue damage. - Is visibly contaminated (for example, if there is dirt or a tooth in the wound).

First Line:

Co-amoxiclav

625mg TDS

Prophylaxis: 3 days

Treatment of active infection: 5 days

First Line (Penicillin allergy):

Doxycycline

AND

Metronidazole

200mg STAT followed by 100mg OD

400mg TDS

Prophylaxis: 3 days

Treatment of active infection: 5 days

First Line (Penicillin Allergy)

Age <12 years old:

Co-trimoxazole

AND

Metronidazole

960mg BD

400mg TDS

Prophylaxis: 3 days

Treatment of active infection: 5 days

Always consider risks of tetanus, rabies, HIV, hepatitis B/C.