Trip Answers

Question answered:28/10/06 Warning! this question is over two years old.

PRODIGY has a guideline on human and animal bites [1].  This has section dealing with both antibiotics and wound closure.

 

Antibiotics prophylaxis

"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:
 - 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.
 - 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).
 - 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:
 - Human bites where there has been clear penetration of the skin.
 - 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 [Dire, 1992; Cummings, 1994].
 - Wounds that have undergone primary closure.
 - People who are at risk of serious wound infection complications, e.g. those who are diabetic, cirrhotic, asplenic, or immunosuppressed [Monteiro, 1995].
 - 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 [Smith et al, 2000].

 

The choice of antibiotic is the same as for treatment of established mild-to-moderate infection (see below).”

 

Wound closure

"Primary closure with sutures is not generally recommended for non-facial bite wounds, especially deep punctures, bites to the hand, and clinically infected wounds. Anecdotal data suggest an increased risk of infection after closure of these wounds. Sterile skin closure strips or delayed closure may be appropriate [Smith et al, 2000]. Delayed closure is usually more appropriate and should also be considered for wounds more than 6 hours old [Dire, 1992].

 

Facial wounds and larger lacerations may require sutures (or sterile skin closure strips) to prevent scarring and improve cosmetic outcome [Smith et al, 2000]. There is uncertainty about the risks of this, but in most cases it is safe providing the person has presented early and the wound has been adequately cleaned [Dire, 1992; Monteiro, 1995].

 

Delayed primary closure (after 3-5 days) is advisable for bites to the hand, bites with extensive crush injury, wounds needing a considerable amount of debridement, and wounds more than 6 hours old [Dire, 1992].

 

Consider referral to accident and emergency/plastic surgery for wounds that may require sutures or delayed primary closure.

 

Cover with a sterile, non-adhesive dressing to protect the wound."

Reference

1) PRODIGY. Bites - human and animal. 2004 (http://www.prodigy.nhs.uk/bites_human_and_animal/view_whole_guidance)

 

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