Prevention of infection after bites from humans and other animals
PROPHYLACTIC ANTIBIOTICS
Give to
All human bite wounds ≤72 hr old, even if no sign of infection
Animal bite wounds if wound ≤48 hr and risk of infection high as follows:
bites to hand, foot, and face
puncture wounds
wounds requiring surgical debridement
crush wounds
wounds in genital areas
wounds with associated oedema
wounds involving joints, tendons, ligaments, or suspected fractures
wounds that have undergone primary closure
patients at risk of serious wound infection (e.g. immunosuppressed) asplenic patients, even after trivial animal bites
patients with prosthetic implants e.g. heart valve, VP shunt
antibiotics not generally needed if wound ≥2 days old and no sign of local or systemic infection
Send swab for bacterial culture and blood culture if systemically unwell
• Co-amoxiclav (if penicillin allergy – clindamycin and cotrimoxazole) for 5 days
TETANUS-PRONE WOUND
• Wounds
that require surgical intervention that is delayed for >6 hr
that show a significant degree of devitalised tissue or a puncture-type injury particularly where there has been contact with soil or manure
containing foreign bodies
in patients who have systemic sepsis
Compound fractures
Immunisation status
Fully immunised, i.e. has received a total of 5 doses of vaccine at appropriate intervals clean wound : vaccine not required
Tetanus-prone wound : vaccine not required , give human tetanus immunoglobulin only if high risk
Primary immunisation complete, boosters incomplete but up to date
clean wound :vaccine not required (unless next dose due soon and convenient to give now)
tetanus-prone wound: vaccine not required (unless next dose due soon)
Human tetanus immunoglobulin: only if high risk
Primary immunisation incomplete or boosters not up to date
Clean wound:A reinforcing dose of vaccine and further doses as required to complete recommended schedule (to ensure future immunity)
Tetanus -prone wound :A reinforcing dose of vaccine and further doses as required to complete recommended schedule (to ensure future immunity) give 1 dose of human tetanus immunoglobulin in a different site
Not immunised or immunisation status not known or uncertain
Clean wound: An immediate dose of vaccine followed, if records confirm the need, by completion of a full 5 dose course to ensure future immunity
Tetanus-prone wound : An immediate dose of vaccine followed, if records confirm the need, by completion of a full 5 dose course to ensure future immunity
give 1 dose of human tetanus immunoglobulin in a different site
* High risk: heavy contamination with material likely to contain tetanus spores and/or extensive devitalised tissue
RABIES
Bat bites in UK
Any animal bite overseas
• Take history of:
• patient name, date of birth, age and address
• date of exposure
• species and current health status of animal involved
• country of exposure
• type of exposure
• site of exposure
• any previous rabies vaccinations