Bites

Organisms Streptococci, Staphylococcus aureus, Anaerobes, Pasteurella multocida, Capnocytophaga canimorsus.
Samples Wound swab if obviously infected. Consider delaying primary closure if infection evident or suspected.
Treatment If skin broken and especially if bite is on foot, face or over a joint, assess rabies risk.  Assess HIV/Hep B/Hep C risk for human bites.
Assess tetanus immunisation status. Cleanse wound thoroughly, debride, consider elevation and immobilisation. Co-amoxiclav 625mg three times daily for seven days. Penicillin allergic individuals, metronidazole 400mg 8-hourly plus doxycycline 100mg twice daily for seven days (NB doxycycline contraindicated in pregnancy).
Referral Contact microbiology if wound fails to improve. Consider referral of wounds with delayed presentation (ie more than 8 hours), punctate wounds unable to be adequately debrided, wounds on hands, feet or face, wounds with underlying structures involved and wounds in the immunocompromised patient.
   Click here for Patient Group Direction for the management of bites

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