For bites and clenched-fist injuries that are not infected, antibiotic therapy is usually not necessary for otherwise healthy individuals if the risk of wound infection is low (eg small wounds not involving deeper tissues that present within 8 hours and can be adequately debrided and irrigated). Give presumptive therapy if the risk of wound infection is high, including if:
- presentation to medical care is delayed by 8 hours or more
- the wound is a puncture wound that cannot be debrided adequately
- the wound is on the hands, feet or face
- the wound involves deeper tissues (eg bones, joints, tendons)
- the wound involves an open fracture—see Open fractures for management
- the patient is immunocompromised (eg due to asplenia or immunosuppressive medications), or has alcoholic liver disease or diabetes
- the wound is a cat bite.
Empirical Antibiotics
- Amoxicillin/Clavulanate oral BD
- Metronidazole + Doxycycline oral BD
- Metronidazole + Sulfamethoxazole/Trimethoprim oral BD
Tetanus
- Normal boosting is every 10 years but we need to identify whether a wound is tetanus-prone
- Bites are tetanus-prone
- Children aged <10 years with a tetanus-prone wound are recommended to receive DTPa or a DTPa combination vaccine
- People aged ≥10 years with tetanus-prone wounds are recommended to receive a booster dose of dT or dTpa if their last dose was more than 5 years ago
- People with uncertain vaccination history and a tetanus-prone wound are recommended to receive tetanus-toxoid vaccine and tetanus immunoglobulin
- People with a tetanus-prone wound and a humoral immune deficiency (including HIV) are recommended to receive tetanus immunoglobulin