Assessment and Management of Animal Bites
Step 1: Health history and physical assessment
Gather information related to the animal and bite/exposure:
• Date and location of exposure
• Type of exposure (bite, scratch, saliva on intact skin, saliva on existing lesion, saliva on mucous membrane, or no known contact)
• Type of attack from the viewpoint of the animal (provoked, unprovoked)
• Wound location
• Animal species
• Animal type (e.g., indoor pet, outdoor pet, wild)
• Health of animal at time of incident and vaccination history
• Symptoms
Assess for risk factors for poor wound healing:
• impaired nutritional status
• advanced age
• medications
• diabetes
• peripheral vascular disease
• autoimmune disease
• immunosuppression
• COPD
• CHF
• anemia
• smoking
• substance use
Consider an x-ray in the following situations: suspected fracture, presence of a foreign body, penetration of bone, joint, tendon, infected puncture wound. Physical assessment:
• inspection for injury to deeper structures (tendon, ligament, bone)
• inspection for presence of a foreign body
• circulation, sensation and movement distal and proximal to the wound
• 2-point discrimination
• sharp/soft discrimination
• pulses
• capillary refill
• range of motion and strength against resistance of all body parts surrounding the wound site
• pain
Step 2: Wash hands, don gloves
Step 3: Cleanse the wound with normal saline
Providers should have high suspicion for the presence of a foreign body (e.g., tooth) in bite wounds. Provide pain management as needed to ensure thorough irrigation is achieved.
Note that some antiseptics (i.e., chlorhexidine, iodine) are cytotoxic and damage fibroblasts essential to wound healing. Do not introduce antiseptic solution directly into the wound. The wound itself should be cleansed or debrided with sterile normal saline only. Alternative methods for wound debridement are below.
(a) Irrigation: Use an 18-gauge catheter attached to a 30 mL syringe. 10 PSI of irrigating pressure is needed to dislodge contaminants and bacteria, yet not damage tissue.
(b) Scrubbing: Use a sponge or a brush to remove embedded debris. Avoid soaps or detergents.
(c) Debridement: Remove retained debris and devitalized tissue by surgical excision to improve wound healing time and prevent disfigurement.
Step 4: Leave wound open to heal by secondary intention
The following wounds are at high risk for development of infection and should not be closed with sutures: Tissue adhesives should be avoided in all situations.
• crush injuries
• puncture wounds
• bites involving the hands and feet
• wounds more than 12 hours old
• cat or human bites
• immunocompromised host
Dress the wound as needed to keep clean and dry and to absorb drainage.
Step 5: Consider prophylactic antibiotics
Prophylactic antibiotics should be prescribed if the wound is:
• more than six hours old
• the result of human or cat bites
• a crushing wound
• grossly contaminated
• bone/joint involvement
• patient is immunocompromised
Use the chart below to determine most likely pathogen and to guide antibiotic treatment.
| Animal | Organisms | First-line therapy | Alternative therapy |
| Dog | Pasteurella spp., S. aureus, Streptococcus spp. | Amoxicillin-clavulanate •3-5 days (prophylaxis) •10-14 days (established infection) |
Doxycycline (>/ 8 years of age)
Clindamycin or fluoroquinolone (adults) Clindamycin or TMP/SMX (children) |
| Cat | Pasteurella spp. (75% of bites) | Amoxicillin-clavulanate •3-5 days (prophylaxis) •10-14 days (established infection) |
Doxycycline (>/ 8 years of age)
Clindamycin or fluoroquinolone (adults) Clindamycin or TMP/SMX (children) |
| Human | Streptococcus spp., S. aureus, Eikenella corrodens, various anaerobic bacteria | Amoxicillin-clavulanate •3-5 days (prophylaxis) •10-14 days (established infection) |
Clindamycin or TMP/SMX |
Step 6: Assess tetanus status
Step 7: Assess need for anti-rabies therapy and complete notification form