Cleanse Wound:
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:
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?
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:
Examine the patient, including:
Culture wound.
Is Antibiotic Prophylaxis Needed?
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:
Systemic infections can occur as well, including:
Careful evaluation of the infectious risks is necessary to determine when prophylaxis is required to prevent serious and life-threatening infections.
3-5 day course of:
Oral:
Intravenous:
Wound Closure:
Do not close:
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).
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 |