Educational revision — for learning, not live patient decisions. Guideline-linked. Always work with your seniors and local guidelines.
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  2. Urgent care
  3. Wounds, burns & skin
  4. Human & animal bites
● Urgent care clinic · 30-minute consult

Human & animal bites

Who gets prophylaxis, rabies risk and the fight bite.

Typical consult⏱ 20–25 min
Investigations🔬 X-ray if bone/joint involvement or tooth fragment
Usual outcome💊 Wash out + co-amoxiclav if indicated
0–5Red flags + history5–12Examine12–17Decide17–24Treat + explain24–30Safety-net + document
1Rule out first — red flags
If you find……then
Bite over a joint or tendon sheath, or a clenched-fist injuryHand surgeons — washout
Bat bite or scratch in the UK, or mammal bite abroad in a rabies countryRabies risk assessment — UKHSA same day
Cellulitis spreading, systemically unwellIV antibiotics
Bite in a child with an inconsistent storySafeguarding
Human bite with blood exposureBlood-borne virus risk (hep B, hep C, HIV)
2Focused history
3Focused examination
4Decide — investigate only if it changes the plan

Antibiotic prophylaxis (NICE NG184)

  • Human bite that broke skin and drew blood → offer
  • Human bite broke skin but no blood → consider if high-risk area (hands, feet, face, genitals, near joint) or high-risk person
  • Cat bite that broke skin and drew blood → offer
  • Cat bite broke skin, no blood → consider if wound could be deep
  • Dog / other mammal bite that broke skin and drew blood → consider (offer if high-risk area or person)
  • Skin not broken → no antibiotics

Prophylaxis course is 3 days; treatment of an infected bite is usually 5 days.

InvestigationOnly if…
X-rayPossible bone/joint involvement or retained tooth
BBV bloodsHuman bites with blood exposure — per local protocol
5Treat & send home

Management & advice

  • Irrigate thoroughly; debride devitalised tissue
  • Leave puncture wounds open; most bites are not closed (face may be closed after specialist advice)
  • Tetanus as for wounds
  • Elevate hand bites

Refer / follow-up

  • Joint/tendon involvement, fight bite → hand / ortho
  • Rabies risk → UKHSA rabies risk assessment service
  • Human bite BBV risk → local post-exposure protocol (hep B vaccine, HIV PEP via sexual health / ED)
℞
Discharge prescription (TTO)Typical adult doses — check the BNF/BNFc, allergies, renal function, pregnancy and interactions.
DrugDoseDuration / notes
Co-amoxiclav500/125 mg three times a dayProphylaxis 3 days; treatment 5 days
Penicillin allergy: doxycycline + metronidazoleDoxycycline 200 mg on day 1 then 100–200 mg daily, plus metronidazole 400 mg three times a dayProphylaxis 3 days; treatment 5 days (doxycycline not in pregnancy / under 12s — seek micro advice)
Paracetamol1 g every 4–6 hours, max 4 g in 24 h (reduce if under 50 kg or liver risk)As needed
6Safety-net
Say it like this

Bites carry a lot of germs, so I’ve cleaned it well and I’m giving you a short course of antibiotics to prevent infection. Keep it raised. Come back today if the redness spreads, it gets more swollen or painful, you can’t move the finger properly, or you feel feverish.

Come back / call 111 — or 999 if severe — if:

  • Redness spreading, swelling, increasing pain, pus
  • Fever or feeling unwell
  • Reduced movement of a finger or joint
7Patient leaflets — scan & go

Official NHS pages. Ask the patient to scan the code with their phone camera, or tap “Show to patient” to make it full screen.

Animal and human bitesnhs.uk/conditions/animal-and-human-bites
Antibiotics — when you need themnhs.uk/conditions/antibiotics
8Document

Human & animal bites — clinic note

A structure to document efficiently. It is not a completeness check — use your trust’s system and your clinical judgement.

URGENT CARE — HUMAN & ANIMAL BITES PRESENTING COMPLAINT: HISTORY Who/what bit, where, when; provoked?: Country (rabies), animal vaccination status if known: Broken skin? Drew blood?: Hand dominance, job: Tetanus; immunosuppression, asplenia, diabetes, cirrhosis: Human bite: source risk factors for BBV: RED FLAGS (record present / absent) [ ] Bite over a joint or tendon sheath, or a clenched-fist injury [ ] Bat bite or scratch in the UK, or mammal bite abroad in a rabies country [ ] Cellulitis spreading, systemically unwell [ ] Bite in a child with an inconsistent story [ ] Human bite with blood exposure PMH: DRUG HISTORY: ALLERGIES: SOCIAL (job / who is at home / driving): OBSERVATIONS: RR SpO2 HR BP Temp (NEWS2 ) EXAMINATION Depth, puncture vs laceration, devitalised tissue: Joint / tendon involvement (examine through range of movement): Neurovascular status: Signs of infection: DECISION RULE — Antibiotic prophylaxis (NICE NG184): result ______ INVESTIGATIONS: none required / X-ray, BBV bloods — result: IMPRESSION: PLAN Treatment / TTO (drug, dose, duration): Advice given: Leaflet given (QR / printed): Animal and human bites, Antibiotics — when you need them Follow-up / referral: SAFETY-NETTING (told to return / call 111 / 999 if): - Redness spreading, swelling, increasing pain, pus - Fever or feeling unwell - Reduced movement of a finger or joint Patient understands and agrees with the plan: Y / N Seen by: Grade: Date/Time:
✓Guidelines

Doses are typical adult doses drawn from the guidance above. Always check the current BNF/BNFc and your local antimicrobial policy.

More wounds, burns & skin

Lacerations & wound careClose it right, check tetanus, and know which wounds aren’t yours.Minor burns & scaldsCool, cover, size it — and know when it goes to the burns unit.Insect bites, stings & tick bitesBig local reactions vs infection vs anaphylaxis — and Lyme.CellulitisOral antibiotics at home or IV? Mark the edges and safety-net.