• Scenario: Assessing a bite: covers the assessment of human and animal bites.
• Scenario: Managing a human bite: covers the management of a human bite.
• Scenario: Managing a cat or dog bite: covers the management of cat and dog bites.

• Document how and when the bite occurred.
• Examine the bite, and document its location, appearance, and any damage to underlying structures (e.g. arteries, nerves, tendons, or joints).
• Determine whether the person is at increased risk of the wound becoming infected, either due to the nature of the bite or due to a medical condition (e.g. diabetes, immunosuppressed status).
• Assess whether the wound is infected. The following may be present: redness, swelling, serosanguinous or purulent discharge, pain, localized cellulitis, lymphadenopathy, or fever.
• Determine tetanus status.
• For human bites: assess whether there is a risk of acquiring a blood-borne viral infection (e.g. hepatitis B or C, or HIV).
• In most cases, the status of the biter will not be known, and it is often not practical to obtain a blood sample for testing. There is a higher risk of acquiring a blood-borne virus if:
• The biter is known to be HIV positive, hepatitis B surface antigen (HBsAg) positive, or hepatitis C positive.
• The biter is likely to be a high-risk person, such as an intravenous drug user.
• Assess the status of the person who has been bitten:
• Ask if they are known to be HIV positive, hepatitis B surface antigen (HBsAg) positive, or hepatitis C positive.
• Check their vaccination status for hepatitis B.
• It is essential to obtain an X-ray in people with the following:
• Clenched fist injuries, to exclude the presence of teeth or dental fragments, and to rule out bone damage.
• Crush injuries, suspected fractures, bites where a foreign body is a possibility.
• For animal bites: assess the risk of acquiring rabies, and discuss the need for post-exposure prophylaxis urgently with the Virus Reference Department of the Health Protection Agency (telephone 020 8327 6017).

• 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

• 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) or bites to poorly vascularized areas e.g. ear cartilage/nose cartilage.
• Devitalized wounds where debridement is required or where there is a possibility of a foreign body (e.g. a tooth) in the wound.
• Wounds which might benefit from closure, or need reconstructive surgery.
• 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).
• Children with scalp wounds (for X-ray).
• If an animal has bitten a child, consider the possibility of poor parenting and supervision. Follow local policies for referral of children considered at risk.
• People who may have been exposed to rabies — seek immediate advice from the Virus Reference Department of the Health Protection Agency.

In depth

• If possible remove any foreign bodies (e.g. teeth) from the wound.
• 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 an animal bite wound.
• Advise analgesia (ibuprofen or paracetamol) for pain relief, if required.
• Prescribe prophylactic antibiotics if the wound is less than 48 hours old and the risk of infection is high.
• Consider if tetanus prophylaxis is required.

In depth

• Prescribe oral 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.

In depth

• For prophylaxis and treatment of an infected animal bite prescribe a 7–day course of co-amoxiclav.
• For people who are allergic to penicillin give metronidazole plus doxycycline, or metronidazole plus oxytetracycline.
• For children under 12 years old who are allergic to penicillin seek advice from a microbiologist.
• For animals not covered in this guidance (e.g. pigs) seek specialist advice for the most appropriate antibiotic.

In depth

• This follow-up advice only applies to people who 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.
• Follow-up for people who have needed post-exposure prophylaxis for rabies should follow the regimen advised for them by the Virus Reference Department of the Health Protection Agency.

In depth