100
75% 100% Zoom 125%


Export to PDF
Contribute Edits
Animal Bites

Cleanse Wound:

  • Gently cleanse wound with at least 250mL of normal saline with a splashguard shield.
  • Do not use hibiclens or povidone-iodine solution.
  • Do not irrigate puncture wounds.

Discharge home with follow up in 48 hours.

Is Tetanus Prophylaxis Needed?

Patient’s Immunization Status

Vaccine Needed?

Tetanus Immune Globulin Needed?

Received fewer than 3 tetanus vaccines or Unknown

Yes

Yes

Received 3 or more vaccines, <5 years since the most recent

No

No

Received 3 or more vaccines, ≥5 years since the most recent

Yes

No

Tetanus vaccine required:

  • Tdap if patient is <7 years old
  • DTaP if patient is ≥ 7 years old

Severe bite wound or patient history of MRSA?

Add vancomycin until cultures return.

Does the patient require tetanus vaccine prophylaxis?

Previously received rabies immunization series or documented rabies antibody titers?

Inclusion Criteria
  • Sustained animal bite wound
Exclusion Criteria
  • Hemodynamic instability
  • Signs of systemic infection

Does the patient require rabies prophylaxis?

Does the patient require tetanus immunoglobulin prophylaxis?

Does the patient require antibiotic prophylaxis?

Administer tetanus immune globulin.

X-ray.

Obtain History, including:

  • Type of animal, domestic or wild
  • Location of bite
  • Timing of bite
  • Patient’s immunization status
  • Assess patient’s risk for infection (e.g., immunocompromised or asplenic)
  • Patient’s allergies

Examine the patient, including:

  • Vital signs
  • Location of bite
  • Characteristics
  • Extension
  • Severity
  • Signs of infection
  • Neurovascular exam

Culture wound.

Gram stain & culture

Is Antibiotic Prophylaxis Needed?

  • Does the patient meet any of the following criteria?
    • Immunocompromised
    • Asplenic
    • Have advanced liver disease
    • Have pre-existing or new edema of the affected area
    • Suffered moderate to severe puncture wounds
    • Injury to bone, tendon, or joint capsule
    • Wounds to face, hand, or genitals

Has it been >8 hours since bite Or are there signs of edema or infection?

Infection is the most common risk associated with animal bites. Infections from animal bites are polymicrobial containing aerobic and anaerobic bacteria from the mouth of the animal and the skin of the victim.

Most frequently isolated bacteria:

  • Pasteurellaspp
  • Staphylococcusspp
  • Streptococci
  • Anaerobes
  • Capnocytophagaspp
  • Moraxellaspp
  • Neisseriaspp
  • Corynebacterium spp

Systemic infections can occur as well, including:

  • Rabies
  • Tetanus
  • Bartonella (cat-scratch disease)
  • Tularemia
  • Brucellosis
  • Leptospirosis

Careful evaluation of the infectious risks is necessary to determine when prophylaxis is required to prevent serious and life-threatening infections.

  • Immediately initiate 4-dose rabies prophylaxis regimen.
  • Immediately administer human rabies immune globulin (HRIG).
  • Infiltrate wound site with HRIG.

Rabies Vaccine
Human rabies immune globulin (HRIG)

3-5 day course of:

Oral:

  • Augmentin-clavulanate
    • For penicillin-allergic patients: Extended-spectum oral cepahlosporin or trimethoprim-sulfamethoxazole
  • PLUS Clindamycin

Intravenous:

  • Ampicillin- sulbactam
    • For penicillin-allergic patient: Extended-spectrum cephalosporin or trimethoprim-sulfamethoxazole
  • PLUS Clindamycin

Wound Closure:

  • Wounds on the face and neck should undergo primary closure after careful irrigation and debridement.

Do not close:

  • Wounds on the hands
  • Wounds >8-12 hours
  • Wounds with early signs of infection

Primary closure of other wounds can be considered on an individual basis.

Immediately administer rabies vaccine today (day 0) and in three days (day 3).

Rabies Vaccine

Is Rabies Prophylaxis Needed?

Animal

Risk

Vaccination Needed?

Immunoglobulin Needed?

Dog, cat, or ferret

Animal is healthy and can be observed for 10 days

No

No

Suspected of being rapid

Yes

Yes

Uncertainty regarding animal’s status

Contact local public health authorities

Contact local public health authorities

Bats, skunks, raccoons, woodchucks, foxes, and other carnivores

Considered high risk unless the animal is proven to be negative by lab results

Yes

Yes

Livestock, rodents, and rabbits

Often low risk for rabies, but local public health officials should be consulted to discuss local patterns of disease

Contact local public health authorities

Contact local public health authorities




100
75% 100% Zoom 125%


Export to PDF