Bites

Key points

Assessment and Management

• Take a careful history and examination; check for additional injuries following APLS guidelines

• Involve paediatrics for safeguarding, assess for non-accidental injury (NAI), and ensure the safety of siblings

Dog Bites

• Typically cause crush injuries

• 15% infection rate, manifesting within 24 hours

Cat Bites

• Punctures - more likely to cause deeper infections, including osteomyelitis

• 37% infection rate, manifesting within 12 hours

Human Bites

• Risk of bacterial and viral infections, including HIV and Hepatitis B

Common Organisms from bites

• Strep, Staph, Actinomyces, Pasteurella

• Capnocytophaga canimorsus sepsis possible from dog bites

Antimicrobial Prophylaxis

• Refer to local guidance, example -

• Administer metronidazole and Tetanus/Diphtheria +/- Pertussis vaccination

• Give Tetanus Immunoglobulin (Ig) if the patient has had fewer than 3 tetanus vaccines and presents with anything other than a clean/minor wound

• If the patient has had 3 or more tetanus doses:

  • For clean wounds, give a booster if the last dose was over 10 years ago

  • For dirty wounds, give a booster if the last dose was over 5 years ago

• Rabies propylaxis is indicated for wild animal bites

  
  

Wound Management

• Can washout and close bites unless visibly infected; no increased infection risk with closure

• Use iodine washout if rabies is suspected

References

Holcomb and Ashcraft’s Pediatric Surgery, 7th edition, 2020, Chapter 12 Bites