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Uninfected human bite wound — MSRA MCQ

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ModerateInfectious DiseasesUninfected human bite woundMSRA

A 29-year-old man attends general practice 4 hours after being bitten on the dorsum of his right index finger during an altercation. The bite has broken the skin and drawn blood. The wound has been thoroughly irrigated. There is no erythema, warmth, swelling, discharge, fever or pain on finger movement. He has full active and passive finger movement, no sensory deficit, and no concern for tendon, joint or bone involvement. His tetanus immunisation is up to date. He has no drug allergies, is not immunosuppressed, has normal renal function and can take oral medication. Which is the most appropriate antibiotic management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Prescribe oral co-amoxiclav 500/125 mg three times daily for 3 days

Explanation lettering: E = shown as A · A = shown as B · B = shown as D · D = shown as E

This is an uninfected human bite that has broken the skin and drawn blood. NICE recommends antibiotic prophylaxis in this situation. In an adult who can take oral medication and has no penicillin allergy, first-choice prophylaxis is co-amoxiclav. The recommended prophylactic course is 3 days; a 5-day course is used for treatment of an established bite-wound infection. A is inadequate because flucloxacillin does not provide the recommended broad coverage for organisms associated with human bite wounds. B uses the appropriate first-line agent but incorrectly uses a treatment-duration course despite the absence of local or systemic infective features. D is an alternative regimen when co-amoxiclav is unsuitable, including penicillin allergy; that does not apply here. E would be inappropriate because visible bleeding after a human bite meets NICE's threshold for prophylaxis, regardless of the current absence of infection. Assessment for blood-borne virus exposure, tetanus status, wound irrigation and safety-netting remain important components of management, but the question asks specifically about antibiotic management.

Reference: NICE NG184: Human and animal bites: antimicrobial prescribing — Recommendations (04 November 2020; current online guidance checked 15 August 2026) — https://www.nice.org.uk/guidance/ng184/chapter/Recommendations Co-amoxiclav 500 mg/125 mg film-coated tablets — Summary of Product Characteristics (2025; checked 15 August 2026) — https://www.medicines.org.uk/emc/product/101680/smpc