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Question answered:31/08/06 Warning! this question is over two years old.
Clinical Evidence contains a chapter on bites (mammalian) which examines the use of antibiotics in both the prevention of complications and the treatment for infected bites (1). The key messages of both have been reproduced below.
Prevention of complications:
“Antibiotic prophylaxis: The effects of antibiotic prophylaxis in preventing complications of mammalian bites remain unclear. Limited evidence from one systematic review found that, when all causes and sites of mammalian bite were combined, there was no evidence of a difference in infection rate between antibiotics and placebo. Meta-analysis according to the site of the wound found that antibiotics reduced infections of the hand only. One small RCT in the review found that in people with human bites, antibiotics reduced the rate of infection compared with placebo.”
Treatment for infected bites:
“Antibiotics: We found no RCTs of antibiotics compared with placebo for infected mammalian bites. However, there is consensus that antibiotics are likely to be beneficial.”
Prodigy has also produced a guideline on bites – human and animal (2) which covers antibiotic prophylaxis in the management issues.
¨ “There are only limited data available on the effect of antibiotic prophylaxis for preventing complications of mammalian bite wounds. A Cochrane systematic review found evidence that:
o Antibiotic prophylaxis significantly reduced the incidence of infection after a dog, cat, or human bite to the hand. Four people need to be given antibiotic prophylaxis to prevent one infection developing after any bite to the hand.
o There are insufficient data to determine whether prophylactic antibiotics are effective for dog or cat bites (only one study with 11 patients analysed cat bites).
o The only trial to analyse human bites found that the infection rate in the antibiotic group was significantly lower than in the control group (0/33 compared with 7/15, p <0.05). This result should be interpreted with caution due to the small sample size (OR 0.02, 95% CI 0 to 0.33).
¨ Antibiotic prophylaxis is generally recommended for:
o Human bites where there has been clear penetration of the skin.
o People with high-risk animal bite wounds, i.e. hand, foot, and facial injuries; puncture wounds (particularly likely with cat bites); wounds requiring surgical debridement; wounds involving joints, tendons, ligaments, or suspected fractures.
o Wounds that have undergone primary closure.
o People who are at risk of serious wound infection complications, e.g. those who are diabetic, cirrhotic, asplenic, or immunosuppressed.
o People with a prosthetic valve or who have suffered a bite proximal to prosthetic joints.
¨ Antibiotics are not generally needed if the wound is more than 2 days old and there is no sign of local or systemic infection.
¨ The choice of antibiotic is the same as for treatment of established mild-to-moderate infection.”
- http://www.clinicalevidence.com/ceweb/conditionpdf/0914.pdf
- http://www.prodigy.nhs.uk/bites_human_and_animal/view_whole_guidance
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