Bite

Jump to navigation Jump to search

WikiDoc Resources for Bite

Articles

Most recent articles on Bite

Most cited articles on Bite

Review articles on Bite

Articles on Bite in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Bite

Images of Bite

Photos of Bite

Podcasts & MP3s on Bite

Videos on Bite

Evidence Based Medicine

Cochrane Collaboration on Bite

Bandolier on Bite

TRIP on Bite

Clinical Trials

Ongoing Trials on Bite at Clinical Trials.gov

Trial results on Bite

Clinical Trials on Bite at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Bite

NICE Guidance on Bite

NHS PRODIGY Guidance

FDA on Bite

CDC on Bite

Books

Books on Bite

News

Bite in the news

Be alerted to news on Bite

News trends on Bite

Commentary

Blogs on Bite

Definitions

Definitions of Bite

Patient Resources / Community

Patient resources on Bite

Discussion groups on Bite

Patient Handouts on Bite

Directions to Hospitals Treating Bite

Risk calculators and risk factors for Bite

Healthcare Provider Resources

Symptoms of Bite

Causes & Risk Factors for Bite

Diagnostic studies for Bite

Treatment of Bite

Continuing Medical Education (CME)

CME Programs on Bite

International

Bite en Espanol

Bite en Francais

Business

Bite in the Marketplace

Patents on Bite

Experimental / Informatics

List of terms related to Bite

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

A bite is a wound received from the mouth (and in particular, the teeth) of an animal or person. Animals may bite in self-defense, in an attempt to predate food, as well as part of normal interactions. Other bite attacks may be apparently unprovoked, especially in the case of bites committed by psychologically or emotionally disturbed humans. Some disorders such as Lesch-Nyhan syndrome may cause people to bite themselves.

Bite wounds raise a number of medical concerns for the physician or first aider including:

Examples

Treatment

Bite wounds are washed, ideally with povidone-iodine soap and water. The injury is then loosely bandaged, but is not sutured due to risk of infection.

Animal bites inflicted by carnivores (other than rodents) are considered possible cases of rabies. The animal is caught alive or dead with its head preserved, so the head can later be analyzed to detect the disease. Signs of rabies include foaming at the mouth, self-mutilation, growling, jerky behavior, and red eyes. If the animal lives for ten days and does not develop rabies, then it is probable that no infection has occurred.

If the animal is gone, prophylactic rabies treatment is recommended in most places. Certain places, such as Hawaii, Australia and the United Kingdom, are known not to have native rabies. Treatment is generally available in North America and the Northern European states.

Antibiotic Therapy

▸ Click on the following categories to expand treatment regimens.

Human Bites

  ▸  Adults

  ▸  Children

Dog Bites

  ▸  Adults

  ▸  Children

Cat Bites

  ▸  Adults

  ▸  Children

Pig Bites (swine)

  ▸  Adults

  ▸  Children

Monkey Bites

  ▸  Adults

  ▸  Children

Tick Bites

  ▸  Adults

  ▸  Children

Rat Bites

  ▸  Adults

  ▸  Children

Early (not yet infected)[1]

Preferred Regimen
Amoxicillin-clavulanate 875/125 mg orally q12h X 5 days
Alternative Regimen (beta-lactam allergy)
Moxifloxacin 400 mg orally q6h AND Clindamycin 300 mg orally q6h
OR
Trimethoprim-sulfamethoxazole 1 double-strength tablet orally q12h AND metronidazole 250 to 500 mg orally q6h
Late (infected)[1]

Preferred Regimen
Ampicillin sulbactam 1.5 gm IV q6h
OR
Cefoxitin 2 gm IV q8h
OR
Ticarcillin clavulanate 3.1 gm IV q6h
OR
Piperacillin-tazobactam 3.375 gm IV q6h or 4.5 gm q8h or 4-hr infusion of 3.375 gm q8h
Alternative Regimen (beta-lactam allergy)
Clindamycin 1.5 gm IV q6h
PLUS
Moxifloxacin 400 mg IV q6h
Early (not yet infected)[1]

Preferred Regimen
Amoxicillin-clavulanate (> 12weeks) 45 mg/kg/day orally in 2 divided doses for 5 days
Late (infected)[1]
Preferred Regimen
Ampicillin sulbactam 100 to 300 mg/kg/day IV q6h
OR
Cefoxitin 80 to 160 mg/kg/day IV in 4 divided doses
OR
Ertapenem (3months - 12years) 15 mg/kg IV twice daily (maximum 1 g/day) OR Ertapenem (>13years) 1 g IV once daily
Early (not yet infected)
Preferred Regimen
Amoxicillin-clavulanate 875/125 mg orally q12h
OR
Amoxicillin-clavulanate 500/125 mg orally q8h
Alternative Regimen (beta-lactam allergy)
Clindamycin 300 mg orally q6h
PLUS
Ciprofloxacin 500 to 750 mg orally q12h
Late (infected)[1]
Preferred Regimen
Ampicillin sulbactam 1.5 to 3 g IV q6-8h
OR
Piperacillin-tazobactam 3.375 gm IV q6-8h
OR
Ertapenem 1 gm IV q24h
OR
Imipenem-Cilastin 1 gm IV q6-8h
OR
Imipenem-Cilastin 1 gm IV q6-8h
OR
Meropenem 1 gm IV q8h
Alternative Regimen (beta-lactam allergy)
Cefazolin 1 gm IV q8h
OR
Cefuroxime 1 gm IV q24h
OR
Cefoxitin 1 gm IV q6-8h
OR
Ceftriaxone sodium 1 gm IV q12h
OR
Cefotaxime 2 gm IV q6h
OR
Ciprofloxacin 400 mg IV q12h
OR
Moxifloxacin 400 mg IV q24h
Early (not yet infected)
Preferred Regimen
Amoxicillin-clavulanate 45 mg/kg/day orally in two divided doses X 3-7 days
Alternative Regimen (beta-lactam allergy)
Clindamycin 20 to 30 mg/kg/day orally in 4 divided doses
PLUS
Trimethoprim component 8 mg/kg/day orally in 2 divided doses
Late (infected)[1]
Preferred Regimen
Ampicillin sulbactam 100 to 300 mg/kg/day IV q6h
OR
Cefoxitin 80 to 160 mg/kg/day IV in 4 divided doses
OR
Ertapenem (3months - 12years) 15 mg/kg IV twice daily (maximum 1 g/day) OR Ertapenem (>13years) 1 g IV once daily
Early (not yet infected)
Preferred Regimen
Amoxicillin-clavulanate 875/125 mg orally q12h
OR
Amoxicillin-clavulanate 500/125 mg orally q8h
Alternative Regimen (beta-lactam allergy)
Doxycycline 100 mg orally q12h
OR
Cefuroxime 500 mg orally q12h
Late (infected)[1]

Preferred Regimen
Ampicillin sulbactam 1.5 to 3 g IV q6-8h
OR
Piperacillin-tazobactam 3.375 gm IV q6-8h
OR
Ertapenem 1 gm IV q24h
OR
Imipenem-Cilastin 1 gm IV q6-8h
OR
Imipenem-Cilastin 1 gm IV q6-8h
OR
Meropenem 1 gm IV q8h
Alternative Regimen (beta-lactam allergy)
Cefazolin 1 gm IV q8h
OR
Cefuroxime 1 gm IV q24h
OR
Cefoxitin 1 gm IV q6-8h
OR
Ceftriaxone sodium 1 gm IV q12h
OR
Cefotaxime 2 gm IV q6h
OR
Ciprofloxacin 400 mg IV q12h
OR
Moxifloxacin 400 mg IV q24h
Cat scratch disease[2][3]
Preferred Regimen
Azithromycin 500 mg orally on day 1, then 250 mg orally once daily X 4 days
Early (not yet infected)
Preferred Regimen
Amoxicillin-clavulanate 45 mg/kg/day orally in two divided doses X 3-7 days
Alternative Regimen
Cefuroxime 10 to 15 mg/kg orally q12h
Cat scratch disease[2][3]
Preferred Regimen
Azithromycin 10 mg/kg orally on day 1, then 5 mg/kg orally X 4 days
Late (infected)
Preferred Regimen
Ampicillin sulbactam 100 to 300 mg/kg/day IV q6h
OR
Cefoxitin 80 to 160 mg/kg/day IV in 4 divided doses
OR
Ertapenem (3months - 12years) 15 mg/kg IV twice daily (maximum 1 g/day) OR Ertapenem (>13years) 1 g IV once daily
High risk bites (deep bites, symptomatic animals)[4][5]

Preferred Regimen (without CNS symptoms)
Acyclovir 12.5–15 mg per kg IV q8h
OR
Ganciclovir 5 mg per kg IV q12h
Preferred Regimen (with CNS symptoms)
Ganciclovir 5 mg per kg IV q12h
High risk bites (deep bites, symptomatic animals)[4][5]

Preferred Regimen (without CNS symptoms)
Acyclovir 12.5–15 mg per kg IV q8h
OR
Ganciclovir 5 mg per kg IV q12h
Preferred Regimen (with CNS symptoms)
Ganciclovir 5 mg per kg IV q12h
Uncomplicated
Preferred Regimen
Amoxicillin-clavulanate 875/125 mg orally q12h
Alternative Regimen (beta-lactam allergy)
Doxycycline 100 mg orally q12h
Rat bite fever[6]
Preferred Regimen
Penicillin G benzathine 600,000 to 1,000,000 units/day IM X 10-14 days
OR
Tetracycline 250 to 500 mg orally q6h
Alternative Regimen
Streptomycin 15 mg/kg/day IM in a single dose or in 2 divided doses X 10-14 days
Early (not yet infected)
Preferred Regimen
Amoxicillin-clavulanate 45 mg/kg/day orally in two divided doses X 3-7 days
Alternative Regimen
Cefuroxime 10 to 15 mg/kg orally q12h
Rat bite fever[6]
Preferred Regimen
Penicillin G benzathine 25,000 to 50,000 units/day IM X 10-14 days
OR
Tetracycline (>8 years) 25 to 50 mg/kg/day orally in 4 divided doses X 10-14 days
Alternative Regimen
Streptomycin 15 mg/kg/day IM in a single dose or in 2 divided doses X 10-14 days
Pig (Swine)
Preferred Regimen
Amoxicillin-clavulanate 875/125 mg orally q12h X 5 days
Alternative Regimen
Ampicillin sulbactam 1.5 to 3 g IV q6-8h


OR
Imipenem 1 gm IV q6-8h
OR
Cephalosporin

Pig (Swine)
Preferred Regimen
Amoxicillin-clavulanate 875/125 mg orally q12h X 5 days
Alternative Regimen
Ampicillin sulbactam 100 to 300 mg/kg/day IV q6h
OR
Imipenem 1 gm IV q6-8h
OR
Cephalosporin
Suspected Leptospirosis[7]
Preferred Regimen
Doxycycline 200 mg orally once within 72 hours of tick removal
Suspected Leptospirosis[7]
Preferred Regimen
Doxycycline (≥8 years) 4 mg/kg (maximum 200 mg) orally once within 72 hours tick removal

Vaccination

Diphtheria, Tetanus, and Acellular Pertussis Vaccine

  • Adults (19 years and older, including pregnant women): 1 dose (0.5 mL) IM once to replace a single dose of tetanus and diphtheria (Td) for adults who have not received a prior dose of Tdap.
  • Pediatrics (13 to 18 years, catch-up): 1 dose (0.5 mL) IM to those who missed the 11- to 12-year Tdap booster dose if they have completed the recommended childhood DTP/DTaP vaccination series.
  • Pediatrics (11 to 12 years): 1 dose (0.5 mL) IM to those who have completed the recommended childhood DTP/DTaP vaccination series and have not received a Tdap booster dose.

Diphtheria and Tetanus Toxoids

    • Adults (19 years and older): 1 dose (0.5 mL) Td IM every 10 years for persons who previously received a one-time dose of Tdap.

Rabies Vaccine and Immunoglobulin

  • Unvaccinated patients exposed to an animal suspected of having rabies:
    • Adults: Rabies immune globulin 20 International Units/kg IM; infiltrate as much as possible of the full dose around wound, give the remainder IM at an anatomic site distant from vaccine administration AND rabies vaccine 1 mL IM in deltoid region as soon as possible after exposure; repeat rabies vaccine dose on days 3, 7, 14, and 28.
    • Pediatrics: Rabies immune globulin 20 International Units/kg IM; infiltrate as much as possible of the full dose around wound(s), give the remainder IM at an anatomic site distant from vaccine administration AND rabies vaccine 1 mL IM in lateral thigh as soon as possible after exposure; repeat rabies vaccine dose on days 3, 7, 14, and 28.
  • Vaccinated patients exposed to animals suspected of having rabies:
    • Adults: 1 mL rabies vaccine IM in deltoid region as soon as possible after exposure, repeat dose 3 days later.
    • Pediatrics: 1 mL rabies vaccine IM in lateral thigh as soon as possible after exposure, repeat dose 3 days later.

Behavior

Biting is an age appropriate behavior and reaction for children 2.5 years and younger. Conversely children above this age have verbal skills to explain their needs and dislikes and biting is not age appropriate. Biting may be prevented by methods including redirection, changing the environment and responding to biting by talking about appropriate ways to express anger and frustration. School age children, those older than 2.5 years, who habitually bite may require professional help. [8]

Biting is also a behavior found in many adult animals (except people),often as part of sexual petting.

See Also

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Stevens DL, Bisno AL, Chambers HF, Everett ED, Dellinger P, Goldstein EJ; et al. (2005). "Practice guidelines for the diagnosis and management of skin and soft-tissue infections". Clin Infect Dis. 41 (10): 1373–406. doi:10.1086/497143. PMID 16231249.
  2. 2.0 2.1 Chia JK, Nakata MM, Lami JL, Park SS, Ding JC (1998). "Azithromycin for the treatment of cat-scratch disease". Clin Infect Dis. 26 (1): 193–4. PMID 9455538.
  3. 3.0 3.1 Maman E, Bickels J, Ephros M, Paran D, Comaneshter D, Metzkor-Cotter E; et al. (2007). "Musculoskeletal manifestations of cat scratch disease". Clin Infect Dis. 45 (12): 1535–40. doi:10.1086/523587. PMID 18190312.
  4. 4.0 4.1 Centers for Disease Control (CDC) (1987). "Guidelines for prevention of Herpesvirus simiae (B virus) infection in monkey handlers". MMWR Morb Mortal Wkly Rep. 36 (41): 680–2, 687–9. PMID 2821376.
  5. 5.0 5.1 Holmes GP, Hilliard JK, Klontz KC, Rupert AH, Schindler CM, Parrish E; et al. (1990). "B virus (Herpesvirus simiae) infection in humans: epidemiologic investigation of a cluster". Ann Intern Med. 112 (11): 833–9. PMID 2160783.
  6. 6.0 6.1 Rupp ME (1992). "Streptobacillus moniliformis endocarditis: case report and review". Clin Infect Dis. 14 (3): 769–72. PMID 1562665.
  7. 7.0 7.1 Farr RW (1995). "Leptospirosis". Clin Infect Dis. 21 (1): 1–6, quiz 7-8. PMID 7578715.
  8. Child Care Links, "How to Handle Biting", retrieved 14 August 2007

External links

Template:Injuries, other than fractures, dislocations, sprains and strains