NICE Issues New Guideline on Antimicrobial Prescribing for Human and Animal Bites

Dawn O'Shea

November 06, 2020

The National Institute for Health and Care Excellence (NICE) has published new guidance setting out an antimicrobial prescribing strategy for human and animal bites in adults and children.

The recommendations include the following:

Antibiotic prophylaxis

  • Human bites:

Do not offer antibiotic prophylaxis if the bite has not broken the skin.

Offer prophylaxis (see recommendations on choice of antibiotic) if the bite has broken the skin and drawn blood.

Consider prophylaxis for a bite that has broken the skin but not drawn blood if it:

  • involves a high-risk area such as the hands, feet, face, genitals, skin overlying cartilaginous structures or an area of poor circulation or

  • is in a person at risk of a serious wound infection.

  • Cat bites:

As above

  • Dog bites:

Do not offer prophylaxis for a bite that has not broken the skin or has broken the skin but not drawn blood.

Offer prophylaxis for a bite that has broken the skin and drawn blood if it:

  • has penetrated bone, joint, tendon or vascular structures or

  • is deep, is a puncture or crush wound, or has caused significant tissue damage or

  • is visibly contaminated.

Consider prophylaxis if the bite has broken the skin and drawn blood if it:

  • involves a high-risk area such as the hands, feet, face, genitals, skin overlying cartilaginous structures or an area of poor circulation or

  • is in a person at risk of a serious wound infection.

Choice of antibiotics for prophylaxis (3 days) and treatment (5 days) in adults:

First-choice oral antibiotic:

  • Co‑amoxiclav 250/125 mg or 500/125 mg three times daily.

Alternative first-choice:

  • Doxycycline 200 mg on day 1, then 100 mg or 200 mg daily

with

Metronidazole 400 mg three times a day.

First-choice intravenous antibiotic:

  • Co‑amoxiclav 1.2 g three times daily.

Alternative first-choice intravenous antibiotics:

  • Cefuroxime 750 mg three times daily (increased to 750 mg four times daily or 1.5 g three or four times daily if the infection is severe)

with

Metronidazole 500 mg three times daily.

with

Metronidazole 500 mg three times daily.

Antibiotics for prophylaxis (3 days) and treatment (5 days) in children

For children aged <1 month: seek specialist advice.

First-choice oral antibiotic for children ≥1 month:

Co‑amoxiclav:

  • 1-11 months: 0.25 ml/kg of 125/31 suspension three times daily;

  • 1-5 years: 0.25 ml/kg or 5 ml of 125/31 suspension three times daily;

  • 6- 11 years: 0.15 ml/kg or 5 ml of 250/62 suspension three times daily;

  • 12-17 years: 250/125 mg or 500/125 mg three times daily.

  • Co‑amoxiclav 400/57 suspension may be considered for twice-daily dosing.

Alternative first-choice oral antibiotic for children <12:

  • Co‑trimoxazole (off-label use):

    • 6 weeks to 5 months: 120 mg or 24 mg/kg twice daily;

    • 6 months to 5 years: 240 mg or 24 mg/kg twice daily;

    • 6-11 years: 480 mg or 24 mg/kg twice daily.

Alternative first-choice for people aged 12-17 years:

  • Doxycycline 200 mg on day 1, then 100 mg or 200 mg daily

with

Metronidazole 400 mg three times daily.

First-choice intravenous antibiotic:

  • Co‑amoxiclav:

  • 1-2 months: 30 mg/kg twice daily;

  • 3 months to 17 years: 30 mg/kg three times daily (maximum per dose 1.2g).

Alternative first-choice intravenous antibiotics

  • Cefuroxime (caution in penicillin allergy):

  • 1 month to 17 years: 20 mg/kg three times daily (maximum 750 mg per dose);

  • Increased to 50 mg/kg to 60 mg/kg three or four times daily if needed (maximum per dose 1.5 g).

with

Metronidazole:

  • 1 month: loading dose 15 mg/kg, then (after 8 hours) 7.5 mg/kg three times daily;

  • 2 months to 17 years: 7.5 mg/kg three times daily (maximum per dose 500 mg).

  • Ceftriaxone:

  • 1 month to 11 years (<50 kg): 50 mg/kg to 80 mg/kg once daily (maximum 4 g per day);

  • 9-11 years (≥50 kg) and 12-17 years: 1-2 g once daily.

with

Metronidazole:

  • 1 month: loading dose 15 mg/kg, then (after 8 hours) 7.5 mg/kg three times daily;

  • 2 months to 17 years: 7.5 mg/kg three times daily (maximum per dose 500 mg).

This article originally appeared on Univadis, part of the Medscape Professional Network.

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