A mother calls you on the telephone and says that her 4-year-old son bit the hand of her 2-year-old son 2 days ago. The area around the injury has become red, indurated, and tender, and he has a temperature of 39.4degC (103degF). Which of the following is the most appropriate response?
Correct Answer: Admit the child to the hospital immediately for surgical debridement and antibiotic treatment.
Description: Human bites can pose a significant problem. They can become infected with oropharyngeal bacteria, including S aureus, Streptococcus viridans, Eikenella corrodens, and anaerobes. A patient with an infected human bite of the hand requires hospitalization for appropriate drainage procedures, Gram stain and culture of the exudate, vigorous cleaning, debridement, and appropriate antibiotics. The infected wound should be left open and allowed to heal by secondary intention (healing by granulation tissue rather than closure with sutures). Empiric antibiotic therapy for an infected bite should be penicillinase-resistant; amoxicillin-clavulanate orally, or ticarcillin-clavulanate or ampicillin-sulbactam IV are good choices. Antibiotic prophylaxis for noninfected bite wounds remains controversial, but some experts recommend prophylaxis for all significant human bites.
Category:
Pediatrics
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