• Refer to secondary care:
• Penetrating wounds involving arteries, joints, nerves, muscles, tendons, bones, or the central nervous system. Note: penetrating bites to the hands or feet are at particular risk of infection and serious complications.
• Facial wounds (excluding very minor wounds).
• Bites where there is a possibility of a foreign body (e.g. a tooth) in the wound.
• Devitalized wounds where debridement is required.
• Bites where the severity of the injury is difficult to assess.
• People with severe cellulitis, or with infected bite wounds that are not responding to treatment, or who are systemically unwell.
• People with an increased risk of infection — including those with diabetes or cirrhosis, those who are immunocompromised, and asplenic individuals (especially if they are not taking prophylactic penicillin).
• Injuries requiring reconstructive surgery.
• Bites to poorly vascularized areas e.g. ear cartilage/nose cartilage.
• If adult bites have been inflicted on a child, consider child protection issues. Follow local policies for referral of children considered at risk.

In depth

• If the wound has just occurred, encourage it to bleed, unless it is already bleeding freely.
• Irrigate thoroughly with warm, running water.
• Wound closure is rarely advised in primary care. For more information, see When to close a human bite wound in Detailed information.
• Advise analgesia (paracetamol or ibuprofen) for pain relief, if required.
• Prescribe prophylactic antibiotics for for all human bite wounds under 72 hours old, even if there is no sign of infection.
• Consider if tetanus prophylaxis is required.
• Where body tissue has been torn off as a result of a bite, wrap any torn off parts (e.g. part of an ear) in clean tissue and store in a plastic bag surrounded by ice for transport to hospital.
• Seek immediate advice from a consultant in infectious diseases for anyone considered to be at risk of HIV or hepatitis B. For more information, see Managing risk of a viral infection.

In depth

• Send pus or a deep wound swab for culture, before cleaning the wound. State on the form that the swab is from an infected human bite.
• Treat empirically for 7 days with oral antibiotics.
• Admit anyone who has a severe infection or who is systemically unwell.

In depth

• For both prophylaxis and treatment of an infected human bite prescribe a 7-day course of co-amoxiclav.
• For people who are allergic to penicillin prescribe a 7-day course of:
• Metronidazole plus doxycycline, or
• Metronidazole plus erythromycin, or
• Metronidazole plus clarithromycin.

In depth

• This follow-up advice only applies to people have not been referred to hospital.
• If the bite wound is not infected — advise the person to check for signs of infection and if these develop to attend urgently for review.
• If the wound is infected — review at 24 and 48 hours to ensure the infection is responding to treatment. Advise the person to attend urgently for review if the infection worsens or if they feel increasingly unwell.
• For follow-up of people who are at high risk of a blood-borne virus, see Managing risk of a viral infection.

In depth