Principles of management of bites and clenched-fist injuries

The recommended management of bites and clenched-fist injuries is thorough cleaning, irrigation, debridement, elevation and immobilisation.

Carefully examine bite wounds and clenched-fist injuries to identify deeper injuries, devitalised tissue and retained foreign bodies, particularly for bites inflicted by animals with small teeth.

Postexposure rabies or lyssavirus prophylaxis is required for some bites, for example bat bites (see the Australian Immunisation Handbook for further information). For human bite injuries with associated blood exposure, consider the need for postexposure prophylaxis against bloodborne viruses (eg hepatitis B, HIV).

For patients with bite or clenched-fist injuries, ensure that tetanus immunisation is up-to-date (see Requirement for tetanus prophylaxis).

Antibiotic therapy is required for infected bites and clenched-fist injuries (see Localised infection or Infection associated with systemic symptoms or deeper tissues). 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.

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.