Clinical update

Human and animal bites: assessment, treatment and when to use antimicrobials

Advice from NICE on how to treat patients with bite wounds

Advice from NICE on how to treat patients with bite wounds

Essential information

Human and animal bites are an infection risk and are seen relatively frequently in emergency departments (EDs) and primary care. Dog and human bites are the most common bites encountered in EDs in the UK and can cause significant tissue damage.

Whats new?

Guidance on treating and assessing human and animal bites has been published by the National Institute for Health and Care Excellence (NICE) .

It sets out when antibiotic prophylaxis is needed, and which antibiotics should be prescribed. Antibiotics are generally not required when the bite has not broken the skin, however different approaches are needed to manage

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Advice from NICE on how to treat patients with bite wounds

Image showing 'Beware of the dog' sign on a gate
Picture: iStock

Essential information

Human and animal bites are an infection risk and are seen relatively frequently in emergency departments (EDs) and primary care. Dog and human bites are the most common bites encountered in EDs in the UK and can cause significant tissue damage.

What’s new?

Guidance on treating and assessing human and animal bites has been published by the National Institute for Health and Care Excellence (NICE).

It sets out when antibiotic prophylaxis is needed, and which antibiotics should be prescribed. Antibiotics are generally not required when the bite has not broken the skin, however different approaches are needed to manage the risks depending on what animal has bitten the patient.

Assessment

Assess the type and severity of the bite, including what animal caused the bite, the site and depth of the wound and whether it is infected. Assess the risk of tetanus, rabies or a blood-borne viral infection and take appropriate action.

Manage the wound with irrigation and debridement as necessary. Nurses should consider specialist advice from a microbiologist on bites from exotic pets or animals with which they are unfamiliar.

Risk factors

Children are the most represented group of people in terms of dog bite injury, with the highest incidence in mid-to-late childhood, according to the World Health Organization. The risk of injury to the head and neck from dog bites is greater in children than in adults, adding to the severity of such cases, as well as the necessity for medical treatment and the death rate. Adult women are most likely to receive cat bites.

Most human bites occur during physical fights that involve punching, according to the NHS. Human bites can also occur during contact sports, seizures, vigorous sex, and in domestic violence or sexual assault incidents.

High-risk areas for bites to become infected include the hands, feet, face, genitals, skin overlying cartilaginous structures or an area of poor circulation, NICE says. High risk also applies to those more likely to develop a serious wound infection because of a comorbidity, such as diabetes, immunosuppression, asplenia or decompensated liver disease.

How you can help your patient

  • Antibiotics should be offered if the bite has drawn blood. Consider antibiotic treatment for human and cat bites that have broken the skin but not drawn blood.
  • Antibiotics should be considered for a dog bite if it has caused considerable deep tissue damage, or if the wound is visibly contaminated (for example, with dirt or a tooth), is in a high-risk area, or the person who has been bitten is at high risk of infection.
  • Antibiotics should be offered for a bite if there are symptoms or signs of infection, such as increased pain, inflammation, fever, discharge or an unpleasant smell.
  • Take a swab for microbiological testing to guide treatment if there is discharge (purulent or non-purulent) from the wound.
  • Refer the patient to hospital if there are signs of a serious illness, such as severe cellulitis, abscess, osteomyelitis, septic arthritis, necrotising fasciitis or sepsis, or a penetrating wound involving bones, joints, tendons or vascular structures. Consider referral or seek specialist advice if, for example, the person is systemically unwell, has an infection after taking prophylactic antibiotics, cannot take oral antibiotics or has an infection that is not responding to antibiotics.
  • Reassess the bite if symptoms or signs of infection develop or worsen rapidly or significantly at any time, or do not start to improve within 24-48 hours of starting treatment, or the person becomes systemically unwell or has severe pain that is out of proportion to the infection.
  • Be aware of potential safeguarding issues in vulnerable adults and children.

Expert comment

Carole Young, lead tissue viability specialist nurse, Cambridge University Hospitals NHS Trust

Carole Young, lead tissue viability specialist nurse, Cambridge University Hospitals NHS Trust

‘Bites are a common problem that lead people to seek healthcare.

‘The NICE guidance provides useful, straightforward advice on when antibiotics are needed and which should be given. The type of wound can vary a lot, depending on what has done the biting, and it can be extremely serious.

‘Dogs tend to cause the most complex wounds, with shearing and pulling of tissues, and often cause a more irregular wound. Human bites are quite different, and create puncture wounds, and there is quite a high risk of someone leaving a tooth behind in the wound.

‘Assessments need to be holistic, taking into account comorbidities that could put someone at higher risk of infection, and it is really important to find out what did the biting, when it happened and how long has passed since it happened.’

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