Soft Tissue & Bone Infections

A quick blurb about animal and human bites—even though these are usually managed by the Emergency Department, there are a few important take-home points to know.

Up to 20% of animal bites become infected—interestingly, cat bites are more likely to become infected (~40%) due to deep puncture wounds as a result of their sharp and narrow teeth, whereas dog bites become infected only in ~5% of patients (although these can be severe due to crush injuries).

After an animal bite, immediate wound irrigation, removal of foreign bodies and debridement can decrease the risk of infection. Also, consider rabies and tetanus prophylaxis!

Generally, we give prophylaxis with augmentin (amoxicillin-clavulanic acid) for a 3-5 day course for any immunosuppressed patient with an animal bite, if the wound is moderate or severe with significant crush injury or edema, or if the face, hands, or a joint is involved. Infected wounds require antibiotic treatment, typically with augmentin, for a 5-10 day course.

For human bites (often the result of a clenched fist injury that develops after a punch to another person’s mouth), the same treatment principles apply with a few exceptions: all patients with a human bite receive augmentin prophylaxis and evaluation for transmission of HIV, as well as hepatitis B and C is recommended.

For PCN-allergic patients who cannot receive augmentin, a fluoroquinolone (such as levofloxacin or ciprofloxacin) plus metronidazole (for anaerobic coverage) can be used.