How do I assess the risk of infection in patients with animal bites, and what follow-up is necessary?

To assess the risk of infection in patients with animal bites, first evaluate the type of animal, bite location, depth, and extent of tissue damage, as these factors influence infection risk. Cat bites and deep puncture wounds carry a higher risk of infection compared to dog bites due to the nature of the injury and bacterial flora involved NICE CG64 Stefanopoulos et al. 2004. Consider patient-specific factors such as immunosuppression, diabetes, or peripheral vascular disease, which increase susceptibility to infection NICE CG64. Early signs of infection include erythema, swelling, warmth, pain, and purulent discharge; systemic signs such as fever warrant urgent reassessment NICE CG64 Stefanopoulos et al. 2004.

Initial management should include thorough wound cleaning and irrigation to reduce bacterial load NICE CG64 Stefanopoulos et al. 2004. Prophylactic antibiotics are recommended for high-risk wounds, including deep puncture wounds, bites to the hand or face, immunocompromised patients, and those with delayed presentation NICE CG64. Amoxicillin-clavulanate is the first-line antibiotic choice due to its broad coverage of common pathogens including Pasteurella species NICE CG64 Stefanopoulos et al. 2004.

Follow-up is essential to monitor for signs of infection progression. Patients should be advised to return promptly if symptoms worsen or systemic signs develop. A review within 24 to 48 hours is recommended for high-risk wounds or if prophylactic antibiotics are prescribed NICE CG64. Wound care instructions should be reinforced, and tetanus immunisation status must be checked and updated as necessary NICE CG64. Referral to specialist care is indicated if there is evidence of deep tissue involvement, abscess formation, or failure to respond to initial treatment NICE CG64 Stefanopoulos et al. 2004.