Human and animal bites: Acute care and follow-up

During the initial evaluation, obtain a complete history of the incident and ask about drug allergies, previous tetanus immunization, and conditions such as diabetes that might predispose the patient to infection. Give a tetanus-diphtheria toxoid booster dose to bite victims who have not been vaccinated within the past 5 years. If a patient presents more than 12 to 24 hours after a bite, leave the wound open. In addition, primary closure is not recommended for hand wounds or cat bites. Other fresh wounds can be sutured after devitalized tissue has been debrided. Prescribe a 3- to 5-day regimen of prophylactic antibiotic therapy for patients with high-risk wounds (bites on the hand or genital region, human or cat bites, and crush or puncture injuries) and those with immunosuppressive conditions. amoxicillin-clavulanate is the first choice for prophylaxis and empiric treatment of infection; alternatives are second-generation cephalosporins, doxycycline, clidamycin plus trimethoprim-sulfameth-oxazole, and clindamycin plus a fluoroquinolone. In hunan bite wounds, HIV post-exposure prophylaxis (PEP) is indicated when either participant is HIV-positive or at high risk; when one of the involved is infected with hapatitis B virus, PEP is given to the noninfected person, if not previously vaccinated.