BITES

Question 1

Human/animal bites

Answer 1

Human and animal bites that cause a break in the skin are an infection risk.

Question 2

Assessment of pt with human/animal bite

Answer 2

risk of tetanus, rabies, or a blood-borne viral infection (such as HIV, and hepatitis B and C),

Question 3

When would you refer a bite to the hospital?

Answer 3

• severe cellulitis, abscess, osteomyelitis, septic arthritis, necrotising fasciitis, or sepsis)
• or a penetrating wound involving the arteries, joints, nerves, muscles, tendons, bones or the central nervous system.

Question 4

When would you offer abx prophylaxis

Answer 4

• cat or human: broken skin + drawn blood
• dog or other: broken skin + drawn blood if it has: penetrated bone, joint, tendon, deep, visibly contaminated

Question 5

When would you CONSIDER abx prophylaxis

Answer 5

• cat bite: broken skin but not drawn blood and wound could be deep
• human: broken skin but not drawn blood
• dog: broken skin + drawn blood if it involves high risk area or comorbidity = increased risk of serious wound infection

Question 6

Human and animal bites: 1st line treatment

Answer 6

Co-amoxiclav

Question 7

Human and animal bites: 2nd line treatment

Answer 7

e.g. penicillin allergy
Doxycycline and metronidazole
Doxy = broad
Metro = fights other bacteria

Question 8

Duration of prophylaxis

Answer 8

3 days - if there is no sign of infection yet

Question 9

Duration of treatment

Answer 9

5 days

Question 10

Lyme disease

Answer 10

It is transmitted to humans by the bite of an infected tick.
Most tick bites do not cause Lyme disease, and the prompt and correct removal of the tick reduces the risk of infection.

Question 11

Symptons of Lyme disease

Answer 11

• erythema migrans rash
• usually 1–4 weeks after a tick bite, but can appear from 3 days to 3 months,
• non-focal (non-organ related) symptoms: fever, swollen glands, malaise, fatigue, neck pain or stiffness, joint or muscle pain, headache, cognitive impairment, or paraesthesia.

Question 12

Tick bites (Lyme disease): 1st line treatment

Answer 12

1. Doxycycline (100mg BD)

Question 13

Tick bites (Lyme disease): 2nd line treatment

Answer 13

2. Amoxicillin
   If both doxyxycline and amoxicillin unsuitable = azithromycin

Question 14

Human/animal scratches

Answer 14

Flucloxacillin