Bites, Human and clenched fist injuries

Question 1

Commonest organism?

Answer 1

Human bites, including clenched fist injuries, often become infected by organisms such as Staphylococcus aureus.

Question 2

Principles of treatment

Answer 2

Clean and debride the wound carefully

• e.g. aqueous antiseptic solution or hydrogen peroxide)

Give prophylactic penicillin if a severe or deep bite

Avoid suturing if possible

Tetanus toxoid

Consider possibility of HIV, Hepatitis B or C infections

Question 3

For high risk wounds

Answer 3

Take swab

Procaine penicillin 1.5 g IM, statim + amoxycillin/clavulanate 875 mg, bd for 5 d

children: 15 mg/kg up to 875 mg) (o)

Question 4

For established infection

Answer 4

or severe penetrating injuries (e.g. joints, tendons)

• Metronidazole 400 mg (o) bd + cefotaxime or ceftriazone 1 g IV daily for 14 d (after taking a swab)