Bites and Stings

Prevention of secondary infection

• Amoxicillin (Amoxycillin), oral, 

Adults

500mg 8 hourly for 5 days

Children 

6-12 years; 250 mg 8 hourly for 5 days 

1-5 years; 125 mg 8 hourly for 5 days 

1 year; 62.5 mg 8 hourly for 5 days 

The black-necked cobra or the spitting cobra sprays its venom into the eyes of its victim. 

It causes irritation of the eyes and may cause conjunctivitis and even blindness if not washed away immediately.

Treatment

• Irrigate the eye with any liquid available (water, milk, saline etc).
• Instil diluted anti-venom (one part to five parts of Sodium Chloride 0.9%).
• Treat as corneal abrasion with topical antibiotics (See section on ‘Eye disorders’)

Human bites (which usually occur during fights) lead to infections, which if neglected, almost invariably produce a highly destructive,  necrotizing lesion contaminated by a mixture of aerobic and anaerobic organisms. A deliberately inflicted bite on the hand or elsewhere should be considered as contaminated.

Symptoms

• Pain
• Swelling
• Bleeding
• Fever, if bites get infected

Signs

• Teeth impression on bitten site
• Wound

Treatment 

Treatment objectives

• To relieve pain
• To treat any secondary infection

Non-pharmacological treatment

• Clean wound thoroughly 

Pharmacological treatment 

1^st Line Treatment

Evidence Rating: [C]

• Tetanus prophylaxis (See section on ‘Tetanus prophylaxis’)
• Flucloxacillin, oral,

Adults

500 mg 6 hourly for 7 days

Children

5-12 years; 250 mg 6 hourly for 7 days

1-5 years; 125 mg 6 hourly for 7 days

> 1 year; 62.5 mg 6 hourly for 7 days

And

• Amoxicillin (Amoxycillin), oral, 

Adults

500 mg 8 hourly for 7 days

Children

6-12 years; 250 mg 8 hourly for 7 days

1-5 years; 125 mg 8 hourly for 7 days

< 1 year; 62.5 mg 8 hourly for 7 days

Note: As a general rule, do not suture wound from human bites

Referral Criteria 

Refer if there is necrotising fasciitis. (See guidelines on necrotising fasciitis)

Mammals, including dogs, may carry the rabies virus. Saliva from an infected animal contains large numbers of the rabies virus which is  inoculated through a bite, laceration, or a break in the skin. There is also risk of tetanus and other bacterial infection following the bites of any mammal.

Symptoms

• Pain
• Swelling
• Bleeding
• Fever, if bites get infected

Signs

• Teeth impression on bitten site
• Wound

Treatment Treatment objectives

• To treat laceration
• To prevent rabies infection
• To prevent other infections
• To treat any secondary infection

Non-pharmacological treatment

Immediate local care

• Wash site with soap and water
• All injuries-abraded skin: minor bites and scratches, major bites and scratches are treated in the same way by thorough irrigation with copious amounts of saline solution or cleansing with cetrimide plus chlorhexidine solution

Pharmacological treatment 

1^st Line Treatment

Evidence Rating: [A]

• Flucloxacillin, oral,

Adults

500 mg 6 hourly for 7 days  

Children

5-12 years; 250 mg 6 hourly for 7 days

1-5 years; 125 mg 6 hourly for 7 days

> 1 year; 62.5 mg 6 hourly for 7 days

And

• Amoxicillin (Amoxycillin), oral, 

Adults

500 mg 8 hourly for 7 days  

Children

6-12 years; 250 mg 8 hourly for 7 days

1-5 years; 125 mg 8 hourly for 7 days

< 1 year; 62.5 mg 8 hourly for 7 days

Update or provide (if not previously immunised) tetanus immunisation (See section on ‘Tetanus Immunisation’) 

Indication for use of Rabies Immunoglobulin and Rabies vaccine

It  should  be  remembered  that  not  every  animal  carries  rabies, although the possibility should be borne in mind for every animal bite. The  treatment provided is dependent on both the certainty of the presence of  the rabies virus in the animal and the immunisation state of the patient.

Rabies Immunisation post exposure

Patients vaccinated within last three years:

Day 0

Infiltrate wound and around wound with 

• Rabies immunoglobulin (10 IU/kg body weight); 

And

• Rabies Immunoglobulin (10 IU/kg body weight) by IM injection;
• 1 ml Rabies vaccine by IM injection

Day 3 (or any day up to day 7)

• 1 ml Rabies vaccine by IM injection

Patients with no vaccination or more than 3 years since vaccination:

Day 0

Infiltrate wound and around wound with 

• Rabies immunoglobulin (10 IU/kg body weight); 

And

• Rabies Immunoglobulin (10 IU/kg body weight) by IM injection;
• 1 ml Rabies vaccine by IM injection Days 3, 7, 14, 30 

Note: 

• Evidence shows that when this vaccine is injected into the gluteal region there is a poor response. Always use the deltoid muscle, or in small children the anterolateral thigh, to give the IM injection of rabies vaccine.
• Always complete the rabies vaccine monitoring form. Check availability of treatment for the next patient
• First dose of anti-rabies vaccine may be given whilst observing for presence or absence of rabies in the dog
• These guidelines are prepared with respect to the use of Rabies Immunoglobulin of human origin and human diploid cell rabies vaccine.
• For the use of other products seek advice and guidance from the Pharmacist or SMO Public Health at either Regional or District level.

Prophylactic immunisation should be offered to those at high risk (eg. laboratory staff working with rabies virus, animal handlers, veterinary  surgeons, and wildlife officers likely to be  exposed to bites of possibly infected wild animals). 

Rabies vaccine, IM, 1 ml on each of days 0, 7 and 28 Booster doses should be given every 2-3 years.

Referral Criteria 

Refer to a tertiary centre when symptoms of rabies set in.