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Guideline review – human and animal bites: antimicrobial prescribing
  1. Peter Fielding,
  2. Shrouk Messahel
  1. Paediatric Emergency Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
  1. Correspondence to Dr Peter Fielding, Paediatric Emergency Department, Alder Hey Children's NHS Foundation Trust, Liverpool L12 2AP, UK; fielding.peter2{at}gmail.com

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Background

An estimated 1%–2% of all new presentations to emergency departments in the UK are caused by animal bites.1 It is reported that roughly 50% of people sustain animal bites in their lifetime, with more than 90% of those from domestic animals.2 Dog bites are the most common presenting bite injury, followed by cat and human bites, respectively.3 4 It is difficult to define the incidence of human and animal bite injuries in the wider population, as many people do not report them, nor do they seek medical attention for them.3

Information about the guideline

This guideline was produced by the National Institute for Health and Care Excellence (NICE) in 2020. There are no former guidelines to which this is an amendment or addition.

The guideline covers the assessment and management of human and common domestic animal bites in adults, young people and children. Its overall aim is to rationalise the use of antibiotics in bite injuries, and to prevent antimicrobial resistance.

Topics covered include distinguishing between infected and non-infected wounds, when to offer antibiotic prophylaxis for non-infected bite wounds and how to treat bites which are suspected to be infected.

Only the paediatric guidance is summarised here. It sits alongside broader NICE guidance on other sources of bites and stings (box 1).

Box 1

Link to the guideline

Other resources

  • NICE guideline on other bites and stings: https://www.nice.org.uk/guidance/conditions-and-diseases/infections/bites-and-stings.

  • NHS advice for patients with animal or human bites: https://www.nhs.uk/conditions/animal-and-human-bites/.

  • Public Health England advice on tetanus prone wounds: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/859519/Greenbook_chapter_30_Tetanus_January_2020.pdf.

Key issues

Assessing a bite wound

Assess and document:

  • Whether the bite is from a human or animal (and from which type of animal).

  • All parts of the anatomy which have sustained a bite wound.

  • The depth of the wound.

  • The risk of tetanus, rabies and bloodborne viral infections, and take appropriate action (beyond the scope of this guideline).

  • Irrigation, cleansing and debridement …

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Footnotes

  • Contributors PF prepared and authored the manuscript, along with all figures and tables (first author). SM reviewed and edited the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

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