Print Print
CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.

Bites - human and animal - Management
Should I give antibiotic prophylaxis to someone with an animal bite?

  • Prescribe antibiotics for:
    • All cat bites, animal bites to the hand, foot, and face; puncture wounds; wounds requiring surgical debridement; wounds involving joints, tendons, ligaments, or suspected fractures.
    • Wounds that have undergone primary closure.
    • People who are at risk of serious wound infection (e.g. those who are diabetic, cirrhotic, asplenic, or immunosuppressed).
    • People with a prosthetic valve or a prosthetic joint.
  • Antibiotics are not generally needed if the wound is more than 2 days old and there is no sign of local or systemic infection.
Basis for recommendation
  • These recommendations are based on published expert opinion [Dire, 1992; Cummings, 1994; Smith et al, 2000; HPA, 2006c; Morgan and Palmer, 2007].
  • Limited evidence from a Cochrane systematic review (only one randomized controlled trial used co-amoxiclav) suggests that antibiotic prophylaxis reduces the incidence of infections from cat bites, and from any type of bite wounds to the hand.
  • Antibiotic prophylaxis following animal bites should be employed selectively, being reserved for the bites most likely to become infected, such as when adequate debridement cannot be achieved, and in immunocompromised people at high risk of infection [HPA, 2006c].
    • High-risk patients with more justification for antibiotic prophylaxis include those with previous mastectomy, prosthetic joints, diabetes, immunosuppression, cirrhosis, steroid therapy, and splenectomy.

© NHS Institute for Innovation and Improvement