Human Bites

Epidemiology: Human bites become infected 10-15% of the time.
- - Occlusional injuries are inflicted by actual biting; clenched-fist injuries result when the fist of one individual strikes the teeth of another.
- - Clenched-fist injuries are more common and typically result in more serious infections (e.g., septic arthritis, tenosynovitis).
Bacteriology: See Table 27-1.

Treatment: Mammalian Bites

Wound management: Wound closure is controversial in bite injuries. After thorough cleansing, facial wounds are usually sutured for cosmetic reasons and because the abundant facial blood supply lessens the risk of infection. For wounds elsewhere on the body, many authorities do not attempt primary closure, preferring instead to irrigate the wound copiously, debride devitalized tissue, remove foreign bodies, and approximate the margins. Delayed primary closure may be undertaken after the risk of infection has passed. Puncture wounds due to cat bites should be left unsutured because of the high rate at which they become infected.
Antibiotic therapy: See Table 27-1. Antibiotics are typically given for 3-5 days (as prophylaxis in pts presenting within 8 h of the bite) or for 10-14 days (as treatment for established infections).
Other prophylaxis: Rabies prophylaxis (passive immunization with rabies immune globulin and active immunization with rabies vaccine) should be given in consultation with local and regional public health authorities. A tetanus booster for pts immunized previously but not boosted within 5 years should be considered, as should primary immunization and tetanus immune globulin administration for pts not previously immunized against tetanus.