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Local Wound Management

The most important step to prevent infection. Every bite is considered contaminated.

1
Copious irrigation: Pressure washing with physiological saline (ideal >100-200 ml per cm of wound). Use a 20-50 cc syringe.
2
Debridement: Remove necrotic tissue, foreign bodies or clots.
3
Suture?:
- Yes (Primary Closure): Face (for aesthetics, irrigate very well), clean bites < 12 hours (or < 24 hours on the face).
- No (Leave open): Human bites, hands, feet, puncture wounds (cat), wounds >12-24h, immunosuppressed.

Treatment of Choice

FIRST LINE

Amoxicillin/Clavulanate

Commercials: Augmentine©, Clavumox©

Dose: 40-50 mg/kg/day (Amoxicillin base) divided every 8 hours.
Duration: 3-5 days (prophylaxis) or 7-14 days (established infection).

Maximum dose: 875/125 mg per dose.

ALLERGIC TO PENICILLIN

Option 1: Clindamycin (Dalacin©)
+ Cefuroxime (Zinnat©) or Cefixime (Denvar©)

Option 2: Trimethoprim-Sulfamethoxazole (Septrin©)
+ Clindamycin (Dalacin©)

Amox/Clav Calculator

Patient weight (kg):

Presentation to use:

Tetanus Prophylaxis in Emergencies

According to the Spanish vaccination schedule (AEP) and characteristics of the wound.

Previous Doses (Vaccine History)	Clean/Minor Wound	Tetanus Wound (Dirty/Bite)
Unknown or <3 doses	Vaccine (Start or complete)	Vaccine + IGT (In a different place)
3 or 4 doses	Vaccine (only if > 10 years ago)	Vaccine (only if > 5 years ago)
≥ 5 doses	Nothing (Full vaccination)	Vaccine (only if > 10 years ago)

Vaccines (Toxoid)

< 7 years: DTPa (Infanrix©) or Hexavalente (Infanrix Hexa©) if it affects the calendar.
≥ 7 years: Tdpa (Boostrix©, Triaxis©). Of current choice versus Td.
Presentation: Prefilled syringe 0.5 ml, IM route (deltoid or anterolateral thigh).

Immunoglobulin (IGT)

Serum: Antitetanus immunoglobulin (Tetagam P©, Igantet©).
Normal dose: 250 IU, via IM.
High dose (500 IU): If wound with >24 hours of evolution, weight >90kg, burns, or highly contaminated.

Anti-rabies Protocol

SPAIN

Urgently Reportable Disease (EDO)!

Any suspected exposure to the rabies virus must be reported immediately to public health authorities to coordinate prophylaxis and epidemiological control.

ASPCAT Protocol (Catalonia) - Professionals

Epidemiological Note: In mainland Spain and islands, the dog/cat is considered free of terrestrial rabies. The main risk is bats (Lysavirus). In Ceuta and Melilla there is a risk from North African dogs. Illegally imported animals also pose a risk.

Post-Exposure Treatment (Patient NOT previously vaccinated):

1 Vaccination (Active)

Commercials: Rabipur©, Verorab©.

Via: 1 ml or 0.5 ml (depending on brand), strict IM route (deltoid, NOT gluteus).

Schedule (Essen Protocol - 4 doses):

Day 0 Day 3 Day 7 Day 14

*In immunosuppressed patients, a fifth dose is added on Day 28.

2 Immunoglobulin (Passive)

Commercial: Imogam Rabia©, Berirab P©.

Indication: Category III (Transdermal bites, scratches with bleeding, contact with saliva on mucous membranes or bats).

Dose: 20 IU / kg of weight

Critical Administration: Infiltrate as much of the dose as possible in and around the wound. Inject the remaining volume IM into an anatomical site distant from that of the vaccine.

Dog

They cause 80-90% of bites. Increased risk of structural damage (crushing, tearing).

Microbiology: Pasteurella canis, S. aureus, Streptococcus, Capnocytophaga canimorsus.

Infection Risk: 5-15%

Cat

Sharp and deep wounds. Very prone to infection. Do not suture generally.

Microbiology: Pasteurella multocida (rapid infection <24h), Bartonella henselae (Scratch disease).

Infection Risk: >50% (High!)

Human

High infection rate. Common in nurseries or fights ("punch against teeth").

Microbiology: Eikenella corrodens, aerobes and anaerobes of the oral cavity.

Assess Serologies: HBV, HCV, HIV.

Rodents / Small mammals

Hamsters, guinea pigs, mice. Risk of fever due to a rat bite (Spirillum minus).

They normally DO NOT require rabies prophylaxis in our environment or systematic ATB if they are healthy domestic pets.