Discuss treatment of pig bites with a microbiologist.
Co-amoxiclav PO dosed as per BNF for Children
Clarithromycin PO dosed as per BNF for Children
Plus Ciprofloxacin PO dosed as per BNF for Children
Plus Metronidazole PO dosed as per BNF for Children
Clarithromycin should not be prescribed concurrently with ciclosporin, sirolimus and tacrolimus.
Prophylactic antibiotics are indicated if the wound has been caused by a cat or pig, or if it is a high risk injury, such as;
- animal bites to the hand, foot, and face and genitalia
- puncture or crush wounds; wounds requiring surgical debridement
- wounds involving bones, joints, tendons, ligaments, or suspected fractures
- bites on limbs with impaired circulation
- wounds that have undergone primary closure
- people who are at risk of serious wound infection (for example those who are diabetic, cirrhotic, asplenic, immunocompromised, or at extremes of age)
- people with a prosthetic valve or joint
- delayed presentation (more than 8 hours but less than 24 - 48 hours)
Take a pus sample or deep wound swab for culture before cleaning the wound and starting antibiotics. State clearly on the form that swab is from an infected animal bite.
Assess the risk of tetanus and rabies. For infected wounds, review at 24 and 48 hours to ensure that infection is responding to treatment, particularly if the patient has been prescribed a non-penicillin based regimen.
If the bite wound is not infected, advise the person to check for signs of infection and if these develop to attend urgently for review
If the wound is infected, review at 24 and 48 hours to ensure the infection is responding to treatment. Advise the person to attend urgently for review if the infection worsens or if they feel increasingly unwell
Primary care: Refer patients with wounds that require surgical debridement or wound closure, wounds on the hand or foot, and wounds that involve joints, tendons, or ligaments. Refer all patients with severe infection and signs of systemic illness.