Pediatric Guidelines: Skin & Soft Tissue Infections - Bite Wound

Condition Major Pathogens First Choice Therapy Alternative Therapy Comments
Bite wound

Pasteurella multocida (animal)

Eikenella corrodens (human)

Staphylococcus spp

Streptococcus spp

Oral anaerobes

Oral (prophylaxis or treatment):

Amoxicillin-clavulanate (Augmentin) 22.5mg/kg/dose amoxicillin PO BID (max 875mg amoxicillin/dose)

Penicillin allergy:

Trimethoprim-sulfamethoxazole (Bactrim/Septra) 4-6mg/kg/dose trimethoprim PO BID (max 160mg trimethoprim/dose)


Clindamycin 10mg/kg/dose PO TID (max 600mg/dose)


3-5 days for prophylaxis of high risk bite wounds

Longer duration for treatment of established infection, guided by severity and clinical course

Also consider need for tetanus and/or rabies prophylaxis

IV (if needed for established infection):

Ampicillin-sulbactam (Unasyn) 50mg/kg/dose ampicillin IV q6h (max 2g ampicillin/dose)

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. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP).