Bite

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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:

• Generalized tissue damage due to tearing and scratching.
• Serious hemorrhage if major blood vessels are pierced.
• Infection by bacteria or other pathogens, including rabies.
• Introduction of venom into the wound by venomous animals such as some snakes.
• Introduction of other irritants into the wound, causing inflammation and itching.

Examples

• Flea bites are responsible for the transmission of bubonic plague.
• Mosquito bites are responsible for the transmission of malaria.
• The bites of various animals may transmit rabies.

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) 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) 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) Preferred Regimen ▸ Amoxicillin-clavulanate (> 12weeks) 45 mg/kg/day orally in 2 divided doses for 5 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 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) 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) 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) 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 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 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) 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) 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 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 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 Preferred Regimen ▸ Doxycycline 200 mg orally once within 72 hours of tick removal Suspected Leptospirosis 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.

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

See Also

• Snakebite
• Spider bite
• Wilderness first aid
• Insect bites and stings

External links

• Treating human bites