close
Animal bite wounds = oral flora of the animal = human skin flora
(Staphylococci + Streptococci)
 
- Aggressive irrigation and debridement
- Appropriate imaging for fracture + foreign body
- Prophylaxis with oral antibiotics
 
< 小孩 + 大狗更需要擔心骨折 > 
Children with facial and scalp bites from large dogs :
skull penetration resulting in brain abscess
 
 狗咬 : 相對較淺,  only 5% of untreated dog bites will become infected ! 
 
 貓咬 : Narrower, sharper teeth than dogs,
deeper small-bore puncture wound.
Up to 80% of cat bites will become infected ! 
 
 
Wound closure is associated with a small increased risk of local wound infection.

Avoid primary wound closure in patients with systemic immunodeficiencies and higher risk wounds
 
高風險傷口處理原則 :
 - Cleaned and debrided of devitalized tissue
 - Avoid closure
 - Dressed with a nonadherent wound dressing
   to maintain a moist environment for epithelial regeneration
 - Re-evaluation in 24 to 48 hours.

Primary closure of open lacerations in healthy patients
要符合以下所有 :
  - Cosmetically important (facial lacerations) 為了美觀
  - Wounds that are clinically uninfected
  - Wounds < 12 hours old (24 hours on the face)
  - Wounds not located on the hand or foot 手腳以外
 
 
以下傷口有高感染機率, 建議不縫 : 
  - Crush injuries
  - Puncture wounds
  - Bites involving the hands or feet 手腳
  - Wounds > 12 hours old (24 hours old on face)
  - Cat or human bites (except those to the face)
  - Bite wounds in compromised hosts
    (Immunocompromised, absent spleen or splenic dysfunction, venous stasis, DM)
 
 
Surgical consultation is warranted for :
  - Deep wounds that penetrate bone, tendons, joints, or other major structures
  - Complex facial lacerations
  - Wounds associated with neurovascular compromise
  - Wounds with complex infections
    (Deep tissue infection, osteomyelitis, or joint infection)
 
 
 Empiric IV antibiotic for dog, cat and human bites 
 - Curam, Tazo
 - Ceftriaxone + Metronidazole
 - Cipro/Levo + Metronidazole
 
 Empiric oral antibiotic for dog and cat bites 
 - Curam
 - Doxycycline
 - Cravit/Levo + Metronidazole
 - 單開 Moxi
 
 Penicillin-allergic patients 
- Doxycycline or cefuroxime for cat bites
- Clindamycin + fluoroquinolone for dog bites.

Cephalexin, dicloxacillin, erythromycin, or clindamycin
should not be used alone for dog or cat bites,
as they do not reliably cover Pasteurella species.
 
Herpes simplex virus can cause local infection, herpetic whitlow
after a human bite or contact with infected saliva
painful coalescence of vesicles, typically on the distal phalanx
oral acyclovir for 7-10 days / topical acyclovir ointment for 7-14 days
 
 
https://www.uptodate.com/contents/clinical-manifestations-and-initial-management-of-bite-wounds?search=dog%20bite%20treatment&source=search_result&selectedTitle=2~39&usage_type=default&display_rank=2#H26
 
 

Capnocytophaga canimorsus :  
rare but fulminant bacteremic illness after a dog bite
multiorgan failure in immunosuppressive 

 

Cat-scratch disease : Bartonella henselae
Regional lymphadenopathy 7-12 days after a cat bite or scratch
painful, matted masses of LNs

Most cases with only LNs involvement resolve in 2-5 months

Avoid incision and drainage, as persistent fistula and scarring 

Antibiotics are not indicated in most cases
Severe painful lymphadenopathy : 5 day course of azithromycin

 

Rat-bite fever
Rigors (嚴重版 Chills) and fevers
Progresses to migratory polyarthralgia and a maculopapular petechial or purpuric rash.
Treatment is with IV penicillin for 5-7 days followed by oral penicillin for an additional 7 days.
Doxycycline or tetracycline is used for penicillin-allergic patients.


Livestock and Large Game Animals
The risk of wound infection is significant, and systemic illnesses 
such as brucellosis, leptospirosis, or tularemia

 

Fish Bites : Vibrio, fluoroquinolone 

 

 

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