see also: [[Wound management]] #incomplete For bites and clenched-fist injuries that are **not infected**, antibiotic therapy is usually not necessary for otherwise healthy individuals if the risk of wound infection is low (eg small wounds not involving deeper tissues that present within 8 hours and can be adequately debrided and irrigated). Give presumptive therapy if the risk of wound infection is high, including if: - presentation to medical care is delayed by 8 hours or more - the wound is a puncture wound that cannot be debrided adequately - the wound is on the hands, feet or face - the wound involves deeper tissues (eg bones, joints, tendons) - the wound involves an open fracture—see Open fractures for management - the patient is immunocompromised (eg due to asplenia or immunosuppressive medications), or has alcoholic liver disease or diabetes - the wound is a cat bite. For wounds on the hands, feet or face, or if infection progresses despite antibiotic therapy, consider surgical consultation. Surgical advice may also be sought on the appropriateness of primary versus delayed wound closure. Antibiotic therapy is required for **infected** bites and clenched-fist injuries. Before starting antibiotic therapy, collect infected tissue for Gram stain and aerobic and anaerobic culture; specify that the sample is from a bite or clenched-fist wound on the laboratory request. ## Antibiotics for bites - amoxicillin+clavulanate 875+125 mg (child 2 months or older: 22.5+3.2 mg/kg up to 875+125 mg) orally, 12-hourly for 3 days - If in community and no access to oral therapy: procaine benzylpenicillin 1.5 g (child: 50 mg/kg up to 1.5 g) intramuscularly, as a single dose while awaiting oral therapy - if oral therapy impaired: augmentin IV - 2g TDS hourly or 1g QID - Pip-taz also an option (main reason for augmentin is slightly narrower spectrum) - If penicillin allergy: - Metronidazole 400mg TDS + - doxyclcline 100mg or 2.2mg/kg in paeds OR - bactrim 160/800 BD ## post-exposure prophylaxis - Post-exposure [[Rabies]] or lyssavirus prophylaxis is required for some bites, for example bat bites. - For human bite injuries with associated [[Needlestick injury#NPEP recomendations|blood exposure]], consider the need for postexposure prophylaxis against bloodborne viruses (eg hepatitis B, HIV).