Human biting injuries
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Overview
Injuries from human bites present a particular risk to other humans, with a major risk of sepsis from infection by human oral bacteria and the possibility of transmission of blood-borne diseases including, syphilis and hepatitis.
Involuntary biting injuries due to closed-fist injuries from fists striking teeth are a common consequence of fist fights. Injuries in which the knuckle joints or tendons of the hand are bitten into tend to be the most serious.
In spite of their name, love bites are not biting injuries (they involve bruising from sucking, and the skin is not broken), although actual biting injuries are sometimes seen as the result of fetishistic activities.
Treatment
Thorough wound cleaning and management is essential: this involves washing out the wound, the removal of any foreign material and debriding any dead or infected tissue. Surgical consultation may be required.
Antibiotics are an important part of the management of a human bite, but are only effective after cleaning of the wound has been completed. Amoxicillin/Clavanulate 625mg thrice daily for at least ten days is the optimal prophylaxis for infection. If the patient is penicillin-allergic, then use doxycycline 100mg twice daily with metronidazole 400mg thrice daily. Macrolides such as clarithromycin or erythromycin must not be used to treat human bites because many human oral commensals are resistant to these antibiotics. Clindamycin is also ineffective
Due to the risk of hepatitis B transmission, the non immunized patient should be offered a dose of Hep B immune globulin, followed by an accelerated course of the Hep B series.