Intended for healthcare professionals

  1. Education
  2. Management of...
  3. Management of mammalian bites
Practice Practice Pointer

Management of mammalian bites

BMJ 2023; 380 doi: https://doi.org/10.1136/bmj-2022-071921 (Published 02 February 2023) Cite this as: BMJ 2023;380:e071921
  1. Isabelle N Colmers-Gray, assistant professor and attending physician, emergency medicine1,
  2. John SP Tulloch, tenure track fellow, veterinary public health2,
  3. Geneviève Dostaler, fellow, hand and upper limb surgery and clinical staff, plastic surgery3,
  4. Anthony D Bai, assistant professor and attending physician, infectious diseases4
  1. 1Department of Emergency Medicine, Queen’s University, Kingston, Ontario, Canada
  2. 2Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
  3. 3Department of Plastic Surgery, Hand and Upper Limb Clinic, University of Western Ontario, London, Ontario, Canada
  4. 4Division of Infectious Diseases, Department of Medicine, Queen’s University, Kingston, Ontario, Canada
  1. Correspondence to I Colmers-Gray Isabelle.gray{at}queensu.ca

What you need to know

  • Copiously irrigate all bite wounds. Smaller bites may be left to heal by secondary intention—with the exception of the face, which can be sutured for cosmetic reasons. Larger bites require re-approximation with interrupted sutures

  • Puncture wounds should not be closed

  • Antibiotic prophylaxis should be given for human bites, most cat bites, bites to high risk areas (face, hands/feet, genitals), deep injuries, or bites closed primarily.

Domestic and wild mammalian bite wounds are increasing.1234 Annually, 15 in 100 000 adults in England are hospitalised for dog bites—rising twofold from 1998 to 2018, faster than the rise in dog numbers.5 A study estimates 17 in 1000 individuals experience animal bites annually, predominantly from dogs, cats, and monkeys.3 Cat bites are highest among women and children and comprise 3% to 25% of all bite wounds, with substantial geographical variation.67 In some areas, dog bites among children increased during the covid-19 pandemic.8

Mammalian bite wounds have high risks of infection and complication910 that can be reduced with proper management. Here we offer generalist and acute care physicians a practical approach to wound management, considerations regarding infection, and public health implications, with a special focus on dogs, cats, and humans. We recommend adapting our guidance to local expertise, resources, and protocols.

What information should be asked on history?

Seek to identify the mechanism of injury, gather information specific to the animal, and assess risk of infection. Key factors to note are:

Animal and injury factors

  • Species and size of animal

  • Animal’s rabies immunisation status (if known)

  • Mechanism of attack (eg, scratch, single bite, multiple bites, clenched jaw with shaking)

  • When the injury occurred

  • Circumstances of the attack (as opportunities for education on future prevention)

Patient factors

  • Extremes of age (which predispose to more severe injury as well as to infection and subsequent complications)

  • Hand dominance

  • Occupation and important …

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