Bite Wound

Bite wound 

High risk bite wounds for which antibiotic prophylaxis recommended:  

Moderate or severe bite wounds, especially if edema or crush injury 

Puncture wounds, especially if penetration of bone, tendon sheath, or joint 

Deep or surgically closed facial bite wounds 

Hand or foot bite wounds 

Genital area bite wounds 

Wounds in immunocompromised and/or asplenic people 

Cat bite wounds 

Pasteurella multocida (animal) 

Eikenella corrodens (human) 

Staphylococcus spp 

Streptococcus spp 

Oral anaerobes 

Oral (prophylaxis or treatment): 

Amoxicillin-clavulanate (Augmentin)
22.5 mg amoxicillin/kg/dose (max 875 mg amoxicillin/dose) enterally bid  

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IV (if needed for established infection): 

Ampicillin-sulbactam (Unasyn)
50 mg ampicillin/kg/dose (max 2000 mg ampicillin/dose) IV q6h  

Penicillin or cephalosporin allergy with higher risk for allergic reaction: 

Trimethoprim-sulfamethoxazole (Bactrim/Septra)
5 mg trimethoprim/kg/ dose  (max 160 mg trimethoprim/dose) enterally bid  

AND 

Clindamycin
10 mg/kg/dose (max 600 mg/dose) enterally tid  

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IV (if needed for established infection): 

Consult ID/ASP 

Duration: 

3-5 days for prophylaxis of high risk bite wounds (see 1st column) 

7-10 days for treatment of established infection, guided by severity and clinical course 

Also consider need for Tetanus and/or Rabies prophylaxis