Further Inpatient Care
- Some patients require hospitalization for surgical intervention, intravenous antibiotic administration, and observation.
- If surgery is not initially performed, admitting the patient allows prompt surgical intervention if no improvement is noted or the clinical situation deteriorates.
- Indications for hospitalization
- Any patient with an injury severe enough to require operative exploration should be observed overnight postoperatively. Some may well require a longer stay, but this is dictated by the specific clinical situation.
- Any patient with systemic manifestations of infection such as fever, chills, or elevated white blood cell count
- Patients with significant comorbidities
- Patients with failure to improve with initial outpatient management
- Patients with a high likelihood of noncompliance (eg, persons who are emotionally disturbed, mentally handicapped, or homeless; persons with chronic alcoholism)
- Patients with infected hand wounds
Further Outpatient Care
- Patients evaluated early, without evidence of infection, and without hand wounds may be treated on an outpatient basis without antibiotics.
- Patients must return within 48-72 hours for reassessment.
- The development of any signs or symptoms of infection indicate the need to seek immediate medical attention.
- Patients with mild-to-moderate infections or hand wounds without infection may also be treated on an outpatient basis with oral antibiotics if they are likely to be compliant with the overall treatment plan.
- Patients must return within 24-48 hours for reassessment.
- They must immediately seek medical attention if their clinical condition deteriorates.
Inpatient & Outpatient Medications
- Antibiotics administered initially or during hospitalization should be continued for the length of time determined by the treating physician.
Complications
- Cosmetic deformity resulting from wound contraction
- Permanent hand disability secondary to stiffness and/or chronic pain
- Tenosynovitis
- Osteomyelitis
- Septic arthritis
- Abscess formation
- Amputation (rare)
- Transmission of disease
Prognosis
- Prognosis is excellent in the compliant patient who promptly seeks medical attention following injury.
Patient Education
- Patients must clearly understand the signs and symptoms of wound infection for which they must return for immediate reevaluation. These include but are not limited to fever, odor, drainage, purulence, swelling, cellulitis, warmth, pain, and decreased mobility.
- Patients must clearly understand the importance of early and regular follow-up care for this seemingly minor injury.
- Patients must clearly understand the rationale for providing antibiotics and the importance of compliance with this recommendation.
- Patients must clearly understand the potential complications that may develop even with complete compliance with the care plan.
- Patients should understand that wound revision for cosmetic or functional purposes might be desirable at a later date.
- For excellent patient education resources, visit eMedicine's Bites and Stings Center and Infections Center. Also, see eMedicine's patient education articles Human Bites and Tetanus.
Khajotia RR, Lee E. Transmission of human immunodeficiency virus through saliva after a lip bite. Arch Intern Med. Sep 8 1997;157(16):1901. [Medline].
Vidmar L, Poljak M, Tomazic J, Seme K, Klavs I. Transmission of HIV-1 by human bite. Lancet. Jun 22 1996;347(9017):1762. [Medline].
Freeman AJ, Senn DR, Arendt DM. Seven hundred seventy eight bite marks: analysis by anatomic location, victim and biter demographics, type of crime, and legal disposition. J Forensic Sci. Nov 2005;50(6):1436-43. [Medline].
Okimura JT, Norton SA. Jealousy and mutilation: nose-biting as retribution for adultery. Lancet. Dec 19-26 1998;352(9145):2010-1. [Medline].
Presutti RJ. Bite wounds. Early treatment and prophylaxis against infectious complications. Postgrad Med. Apr 1997;101(4):243-4, 246-52, 254. [Medline].
Welbury RR, Murphy JM. The dental practitioner's role in protecting children from abuse. 3. Reporting and subsequent management of abuse. Br Dent J. Feb 14 1998;184(3):115-9. [Medline].
Bunzli WF, Wright DH, Hoang AT, Dahms RD, Hass WF, Rotschafer JC. Current management of human bites. Pharmacotherapy. Mar-Apr 1998;18(2):227-34. [Medline].
Chidzonga MM. Human bites of the face. A review of 22 cases. S Afr Med J. Feb 1998;88(2):150-2. [Medline].
Corabianu O, Laredo JD, Woimant F, Haguenau M. Hazards of tongue-biting: Streptococcus oralis bacteraemia and vertebral osteomyelitis following a grand mal seizure. J Neurol. Jan 1998;245(1):47-9. [Medline].
Donkor P, Bankas DO. A study of primary closure of human bite injuries to the face. J Oral Maxillofac Surg. May 1997;55(5):479-81; discussion 481-2. [Medline].
Epstein JB, Scully C. Mammalian bites: risk and management. Am J Dent. Jun 1992;5(3):167-71. [Medline].
Goldstein EJ, Citron DM, Hudspeth M, Hunt Gerardo S, Merriam CV. In vitro activity of Bay 12-8039, a new 8-methoxyquinolone, compared to the activities of 11 other oral antimicrobial agents against 390 aerobic and anaerobic bacteria isolated from human and animal bite wound skin and soft tissue infections in humans. Antimicrob Agents Chemother. Jul 1997;41(7):1552-7. [Medline].
Goldstein EJ, Citron DM, Hudspeth M, Hunt Gerardo S, Merriam CV. Trovafloxacin compared with levofloxacin, ofloxacin, ciprofloxacin, azithromycin and clarithromycin against unusual aerobic and anaerobic human and animal bite-wound pathogens. J Antimicrob Chemother. Mar 1998;41(3):391-6. [Medline].
Griego RD, Rosen T, Orengo IF, Wolf JE. Dog, cat, and human bites: a review. J Am Acad Dermatol. Dec 1995;33(6):1019-29. [Medline].
Kelly IP, Cunney RJ, Smyth EG, Colville J. The management of human bite injuries of the hand. Injury. Sep 1996;27(7):481-4. [Medline].
Ruskin JD, Laney TJ, Wendt SV, Markin RS. Treatment of mammalian bite wounds of the maxillofacial region. J Oral Maxillofac Surg. Feb 1993;51(2):174-6. [Medline].
Ulione MS, Dooling M. Preschool injuries in child care centers: nursing strategies for prevention. J Pediatr Health Care. May-Jun 1997;11(3):111-6. [Medline].
[Guideline] University of Texas, School of Nursing, Family Nurse Practitioner Program. Management of human bite wounds. Austin (TX): University of Texas, School of Nursing; 2007 May. 22 p. [41 references].
Print
