Human Bites

Description

Medicine Treatment

Referral 

---

ICD-10 code: S01.0-9/S11.0-2/S11.7-9/S21.0-2/S21.7-9/S31.0-5/S31.7-8/S41.0-1/S41.7-8/S51.0/S51.7-9/S61.0- 1/S61.7-9/S71.0-1/S71.7-8/S81.0/S81.7-9/S91.0-3/S91.7/T01.0-3/T01.6/T01.8- 9/T09.1/T11.1/T13.1/T14.0-1 + External Cause Code (W,X,Y,Z)

DESCRIPTION

• Human bites may be accidental or intentional (form of assault). 
• Human bites may result in: 
  • Wound infection, often due to mixed aerobic and anaerobic infection.
  • Puncture wounds.
  • Tissue necrosis.
  • Transmission of diseases, e.g. HIV, hepatitis.

MEDICINE TREATMENT

Wound management:

Wash wound thoroughly with soap under running water for 5–10 minutes.

• Chlorhexidine 0.05%, aqueous solution.

Apply disinfectant if available:

• Povidone-iodine 10%, solution.

---

CAUTION
Do not suture bite wounds unless on the head/face. Clean thoroughly, dress (avoid compressive dressings). Review after 48 hours for secondary closure at that time.

---

Tetanus prophylaxis:

ICD-10 code: Z23.5

If not previously immunised within the last 5 years:

• Tetanus toxoid (TT), IM, 0.5 mL.

LoE:IIIa³³

Antibiotic treatment:

Adults and Children > 35 kg

• Amoxicillin/clavulanic acid, oral, 875/125 mg 12 hourly for 5 days.

Children ≤ 35 kg

• Amoxicillin/clavulanic acid oral, 15–25 mg/kg/dose of amoxicillin component, 8 hourly for 5 days.

Click on the image to enlarge.

Severe penicillin allergy:

ICD-10 code: Z88.0

Adults and Children > 35 kg

• Macrolide, e.g.:

Azithromycin, oral, 500 mg daily for 3 days

Children

• Macrolide, e.g.:
• Azithromycin, oral, 10 mg/kg daily for 3 days. See dosing table.

AND

Adults

• Metronidazole, oral, 400 mg, 8 hourly for 5 days

Children

• Metronidazole, oral, 7.5 mg/kg/dose 8 hourly for 5 days. See dosing table.

Hepatitis B prophylaxis (if bite is severe enough to cause bleeding):

ICD-10 code: Z29.8

See: Post exposure prophylaxis, inadvertent (non-occupational).

HIV prophylaxis

The risk of HIV transmission through biting is negligible. Post-exposure prophylaxis is not indicated after a bite.

LoE:IIIb³⁴

REFERRAL

• Deep and large wounds requiring suturing.
• Shock and bleeding.
• Severe infected wounds or infected wounds not responding to oral antibiotics.
• Hand bites.

Click here for the pdf.

Click here for the NEMLC Recommendations for medicine amendments (2020-4 review cycle).

---

Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-4_Version 1.1_October 2024

Chapter 21: Emergencies and Injuries