Bites

625mg every 8 hours for 3 days (for prophylaxis) or 5 days (for treatment)

If allergic to penicillin

100mg every 12 hours for 3 days (for prophylaxis) or 5 days (for treatment)

400mg every 8 hours for 3 days (for prophylaxis) or 5 days (for treatment)

Prescribing Notes:

Thorough irrigation of wound is important.
Assess risk of tetanus, hepatitis B, hepatitis C and HIV.
All human, cat and puncture bites should be treated with antibiotics. Antibiotic treatment should also be given for animal bites to hand, foot and face, wounds involving joints, tendons, ligaments or when patient is asplenic, diabetic, immunocompromised or cirrhotic or in presence of prosthetic valves or joints. If the bite occurred abroad, consider rabies and refer patients to Infectious Disease.
Full information on any required vaccinations can be found in Immunisation against infectious disease - ‘The Green Book’.
All wounds have potential for bacterial infection and may become colonised but swabs should only be taken if there are clinical signs of infection.
Prescription of antibiotics should not delay appropriate surgical management e.g. drainage or aspiration of an abscess.
There is currently deemed to be no risk from rabies from contact with terrestrial mammals (other than imported animals) in the UK. Bats in the UK may carry rabies-like viruses and contact with them needs to be assessed. Scottish Health Protection Network guidance is currently being updated. In the meantime, Public Health England guidance is available on the GOV.UK website.

History Notes

15/12/2021

East Region Formulary content agreed.

For dose and duration see BNFc.

If allergic to penicillin age < 12 years or co-amoxiclav is unsuitable.

For dose and duration see BNFc.

If allergic to penicillin and age 12-17 years or if co-amoxiclav is unsuitable.

For dose and duration see BNFc.

Prescribing Notes:

For more information refer to NICE NG184 Human and animal bites: antimicrobial prescribing.
For treatment options if unable to take oral antibiotics or severely ill refer to local hospital antimicrobial guidelines.
Thorough irrigation of wound is important.
Assess risk of tetanus, rabies, hepatitis B, hepatitis C and HIV.
All human, cat and puncture bites should be treated with antibiotics. Antibiotic treatment should also be given for animal bites to hand, foot and face, wounds involving joints, tendons, ligaments or when patient is asplenic, diabetic, immunocompomised, cirrhotic or in presence of prosthetic valves or joints. If the bite occurred abroad, consider rabies and refer patients to Infectious diseases.
There is currently deemed to be no risk from rabies from contact with terrestrial mammals (other than imported animals) in the UK. Bats in the UK may carry rabies-like viruses and contact with them needs to be assessed. Scottish Health Protection Network guidance is currently being updated. In the meantime, Public Health England Rabies post-exposure treatment: management guidelines are available.
Full information on any required vaccinations can be found in Immunisation against infectious disease - ‘The Green Book’.
A single tetanus vaccine is not available; a combination vaccine may be required. It is useful to clarify vaccination history before giving tetanus as a combined vaccination. See BNFc for current preparations.
Refer patients with heavily soiled or contaminated wounds to A&E for irrigation and tetanus immunoglobulin and vaccine if indicated.
All wounds have potential for bacterial infection and may become colonised but swabs should only be taken if there are clinical signs of infection.
Prescription of antibiotics should not delay appropriate surgical management e.g. drainage or aspiration of an abscess.

History Notes

15/01/2024

East Region Formulary content agreed.