A mnemonic to remember management: HELICOPTER
History, Examination, Liberal cleansing, Irrigation, Closure & Culture consideration, Operative cleansing & closure, Prophylactic antibiotics, Tetanus immunization, Elevation, Rabies risk
History, Examination, Liberal cleansing, Irrigation, Closure & Culture consideration, Operative cleansing & closure, Prophylactic antibiotics, Tetanus immunization, Elevation, Rabies risk
Consider primary closure in face bites   if all of the following are true:
Repair can occur within 6hr of injury (time dependent upon individual judgment)
Repair only requires single-layer closure; no devitalized tissue
No underlying fracture
No systemic immunocompromising conditions
Large gaping wounds outside the face may also require closure with loose approximation
Consider antibiotics in patients who are primarily closed
Repair can occur within 6hr of injury (time dependent upon individual judgment)
Repair only requires single-layer closure; no devitalized tissue
No underlying fracture
No systemic immunocompromising conditions
Coverage for Pasteurella, Strep, and Staph
Consider for high-risk wounds
wounds reaching the level of the muscle/tendon, wounds to the hand, violation of bone or joint capsule, immunocompromised hosts, wounds associated with significant local edema
Amoxicilin-clavulanate 875mg PO BID x 5-7 days OR
Doxycycline 100mg PO BID x 14 days if penicillin allergic 
Clindamycin 450mg (5mg/kg) PO q8hrs daily x7 days PLUS
Ciprofloxacin 500mg PO q12hrs x 7 days OR
TMP/SMX 2DS tabs (5mg/kg) PO q12hrs
wounds reaching the level of the muscle/tendon, wounds to the hand, violation of bone or joint capsule, immunocompromised hosts, wounds associated with significant local edema
Ciprofloxacin 500mg PO q12hrs x 7 days OR
TMP/SMX 2DS tabs (5mg/kg) PO q12hrs
All human bites should be strongly considered for antibiotic therapy.
Requires polymicrobial coverage for: S. aureus, Strep Viridans, Bacteroides, Coagulase-neg Staph, Eikenella, Fusobacterium, Cornebacterium, peptostreptococus
Amoxicilin-clavulanate 875mg PO BID x 5-7days OR
Clindamycin 450mg (5mg/kg) PO q8hrs daily x7 days PLUS
Ciprofloxacin 500mg PO q12hrs x 7 days OR
TMP/SMX 2DS tabs (5mg/kg) PO q12hrs
Ciprofloxacin 500mg PO q12hrs x 7 days OR
TMP/SMX 2DS tabs (5mg/kg) PO q12hrs
Ampicillin/Sulbactam 3g IV (50mg/kg IV) q 6hrs daily OR
Cefoxitin 1g IV q8hrs (25mg/kg q6hrs) OR
Pipericillin/Tazobactam 4.5g IV (80mg/kg IV) q8hrs OR
Ceftriaxone 1g (50mg/kg IV) once + Metronidazole 500mg IV q8hrs OR
Clindamycin 600mg IV q8hrs PLUS
TMP/SMX 5mg/kg IV q12hrs OR
Ciprofloxacin 400mg IV q12hrs OR
TMP/SMX 5mg/kg IV q12hrs OR
Ciprofloxacin 400mg IV q12hrs OR
Monkey Bites:  Acyclovir or Valacyclovir
Monkeys are carriers of Cercopithecine herpesvirus 1 aka Herpesvirus simiae aka B virus.
Valacylovir — 1g PO q8hrs for 14 days or Acyclovir —800mg PO 5 times daily for 14 days
Monkeys are carriers of Cercopithecine herpesvirus 1 aka Herpesvirus simiae aka B virus.
Valacylovir — 1g PO q8hrs for 14 days or Acyclovir —800mg PO 5 times daily for 14 days
Rabies immune globulin should be inidividualized
Indicated for bites from bats, monkeys, skunks, raccoons, foxes.  In the U.S. rare for dog and cat bites to contain rabies (however different rules apply for stray animal in areas with higher rabies incidence)
CDC recommends that if possible, the animal be tested, or quarantined for 10 days monitoring to help with the decision to provide rabies prophylaxis
Indicated for bites from bats, monkeys, skunks, raccoons, foxes.  In the U.S. rare for dog and cat bites to contain rabies (however different rules apply for stray animal in areas with higher rabies incidence)
CDC recommends that if possible, the animal be tested, or quarantined for 10 days monitoring to help with the decision to provide rabies prophylaxis
IDSA suggests considering Tetanus Vaccination in patients whose last Vx was 10 years or more 
Consider hand surgeon consultation early for hand bite infections (see closed fist infection)
Keep involved extremity elevated.
Educate patient to avoid soaking the wound and avoid wrapping bandages too tightly.
Mammalian bites
Hymenoptera stings 
Spider bites
Snake bites
Closed fist infection 
Lizard bites
Dog bite
Octopus bite