Stay up-to-date and safe this summer with the latest NICE antimicrobial prescribing guidelines for insect, animal, and human bites! Thanks to Dr. Caroline Ward for summarizing the recommendations. NICEguidelines
Treat with antibioticsFirst-choice alternative for penicillin allergy or if co-amoxiclav is unsuitable: doxycycline 200 mg on day 1, then 100 mg or 200 mg o.d with metronidazole 400 mg t.d.sFirst choice: co-amoxiclav for children aged <12 years—co-trimoxazole : see BNFC for information on dosing and monitoring
for young people aged 12–17 years—doxycycline 200 mg on day 1, then 100 mg or 200 mg o.d with metronidazole 400 mg t.d.sTreat with antibiotics if significant, deep tissue damage, or visibly contaminatedCConsider antibiotics if bite is in a high-risk area or in a person at high risk of serious infectionSeek specialist advice from a microbiologist for bites from a wild or exotic animal .Consider seeking specialist advice from a microbiologist for domestic animal bites that you are unfamiliar with.
This table includes recommendations about oral antibiotics only. Refer to NICE Guideline 184 for intravenous antibiotic options.[B] A 5-day course is appropriate for treating most human or animal bites, but course length can be increased to 7 days after a review based on clinical assessment of the wound.
[C] High-risk areas include the hands, feet, face, genitals, skin overlying cartilaginous structures, or an area of poor circulation. People at high risk of a serious wound infection include those with co-morbidities .Antibiotic prophylaxis does not reduce the incidence of infection after a bite from a dog or other traditional pet, excluding cats.
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