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1
CKS. Bites – human and animal. Clinical Knowledge Summaries. 2007. http://cks.nice.org.uk/bites-human-and-animal Accessed 23.09.14. RATIONALE: Expert opinion is that prophylaxis for animal bites is not required unless bite to the hand, foot, and face; puncture wounds; all cat bites; wounds requiring surgical debridement; wounds involving joints, tendons, ligaments, or suspected fractures; wounds that have undergone primary closure; wounds to people who are at risk of serious wound infection (e.g. those who are diabetic, cirrhotic, asplenic, immunosuppressed, people with a prosthetic valve or a prosthetic joint).

2
Medeiros I, Saconat H. Antibiotic prophylaxis for mammalian bites. Cochrane Database of Systematic Reviews, 2001 Issue 2 http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001738/pdf_fs.html Accessed 23.09.14. RATIONALE: Human bites: only one trial (n = 48) analyzed human bites, and the infection rate in the antibiotic group (0%) was significantly lower than the infection rate in the control group (47%); OR 0.02, 95% CI 0.00 to 0.33. Dog bites: pooled results from six RCTs (n = 463) found that the infection rate was not reduced after the use of prophylactic antibiotics (4%) compared with the control group (5.5%); OR 0.74, 95% CI 0.30 to 1.8). Cat bites: one small study (n = 11) reported a lower infection rate in the treatment group who received prophylactic antibiotics (0%) compared with the control group (67%).

3
First-line antibiotic. Public Health England and the British Infection Association recommend co-amoxiclav for treatment or prophylaxis of human or animal bites because it is a broad-spectrum antibiotic that is effective against the most commonly isolated organisms from human bites (alpha- and beta-haemolytic streptococci, S. aureus, corynebacteriae, and Eikenella corrodens) and animal bites (such as Pasteurella spp. [57% of dog bites and 75% of cat bites], streptococci, staphylococci, moraxellae, neisseriea, and anaerobes).

4
First-line antibiotics in penicillin allergy for animal bites. Public Health England and the British Infection Association recommend metronidazole PLUS doxycycline for adults with penicillin allergy who require treatment or prophylaxis of an animal bite. Doxycycline has activity against Pasturella species (the most common pathogen), staphylococci and streptococci. Metronidazole is included to cover anaerobes. Macrolides are not recommended for animal bites because they do not adequately cover Pasturella spp. Seek specialist advice for children under the age of 12 years (doxycycline contraindicated).

5
First-line antibiotics in penicillin allergy for human bites. Public Health England and the British Infection Association recommend metronidazole plus either doxycycline or clarithromycin for adults and children with penicillin allergy who require treatment or prophylaxis of a human bite. Both doxycycline and clarithromycin are active against staphylococci and streptococci (the most common pathogens). Metronidazole is included to cover anaerobes. Doxycycline, but not clarithromycin is active against Eikenella species, which is also a common pathogen isolated from human mouths.

6
Public Health England and the British Infection Association recommend that people with penicillin allergy are reassessed at 24 and 48 hours after starting a course of antibiotic treatment because the recommended regimen covers the majority, but not all, of the likely pathogens from an animal or human bite.

The POCAST project is funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London and by the Imperial College Healthcare Charity (Grant Ref No:7006/P36U).