Bite Wound

Patient Population: Pediatric
Condition Major Pathogens  First Choice Therapy Alternative Therapy Comments

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  


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  


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


IV (if needed for established infection)

Consult ID/ASP 


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 


American Academy of Pediatrics. In: Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH, eds. Red Book: 2021 Report of the Committee on Infectious Diseases. 32nd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2021.  

Stevens DL, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis 2014;59:e10-e52. 

Pediatric Empiric Antimicrobial Therapy Guidelines

This is a subsection of the UCSF Benioff Children’s Hospitals Empiric Antimicrobial Therapy Guidelines, developed by the Pediatric Antimicrobial Stewardship Programs at each campus to inform initial selection of empiric antimicrobial therapy for children at the UCSF Benioff Children’s Hospitals and affiliated outpatient sites. 

These are guidelines only and not intended to replace clinical judgment. Modification of therapy may be indicated based on patient comorbidities, previous antibiotic therapy or infection history. Doses provided are usual doses but may require modification based on patient age or comorbid conditions. Refer to Pediatric Antimicrobial Dosing Guideline for further guidance on dosing in children, and Neonatal Dosing Guideline for infants < 1 month of age. Consult a pediatric pharmacist for individualized renal or hepatic dose adjustment. Durations provided are usual recommendations for patients who are responding appropriately to therapy. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP) at the campus where your patient is receiving care.  

For questions or feedback about these guidelines, please email primary content owners, Rachel Wattier, Pediatric ASP Medical Director at BCH SF and Prachi Singh, Pediatric ASP Medical Director at BCH OAK. 

The content of these guidelines was updated in July 2021. See Summary and Rationale for Changes (password login to Box needed) for detailed explanations of the content changes.