Animal bites. Guidelines to current management

Several factors need to be considered when evaluating animal bites. These include type of animal involved, specific nature of the wound, circumstances of the attack, interval between injury and treatment, and location of the bite. Of concern are direct destruction of tissue and risk of infection. Use of antibiotic prophylaxis is controversial, but most authorities agree that it is needed for hand wounds, puncture wounds, or "dirty" wounds of any type in any location. The choice of antibiotic is also controversial, but initial empirical treatment generally relies on broad-spectrum coverage. Rabies prophylaxis is indicated for bites by carnivorous wild animals, bats, and unvaccinated domestic animals. Review of the patient's tetanus status is mandatory.