This document provides clinical guidance for all staff involved in the care and management of a child
presenting to an Emergency Department (ED) following a mammalian bite in Queensland.
This guideline has been developed by senior ED clinicians, with input from infectious diseases,
plastics and pharmacy teams, Queensland Children’s Hospital, Brisbane.

• Mammalian bites are a common ED presentation in children; most are minor.
• Take a detailed history to identify the children who need further investigation.
• Assess vaccination status and consider the need for vaccinations/post exposure prophylaxis.
• Clenched fist injuries (“fight bites”) that penetrate deep tissues and late presentations are
considered high risk for severe infections.
• In most cases there is no indication for blood work or prophylactic antibiotics. Adequate
washout is the most pivotal part of the treatment.

Australia has one of the highest rates of pet ownership in the world. Worldwide around 2% of the total
population are bitten annually1,2,3. Most bites are from domestic animals and majority of bite victims
are children1,2
.
Dog (80-90%) and cat (5 to 10%) bites represent the majority of mammalian bites followed by humans
(2 to 3%) and rodents (2 to 3%)1,2,4,5
.
Risk factors for dog bites are male gender and younger age1,2. Face, neck and head bites are more
frequent in children1,3
.
Bite related injury can vary greatly depending on the bitting animal’s characteristics and the anatomic
location of the bite. Dog bites usually comprise crush injuries, lacerations and abrasions.
Cat bite injuries are usually a puncture wound that could seem minimal at the skin surface but can
penetrate deeper layers including into joints1
. Cat bites tend to have a higher incidence of infection
due to tissue penetration in puncture wounds, and the microbes of the cat oral cavity21
Psychological trauma, including post-traumatic stress disorder, is very common in children who have
experienced dog attacks

The chance of a bite site being
infected varies by species – human and cat bites are the more likely to be infected 1,6
.
• Predominantly cats and dogs:
o Pasteurella sp. should be considered in rapidly progressive skin and soft tissue
infection following mammalian bites. The incubation period for Pasteurella multocida
infection is one to three days.
o Capnocytophaga canimorsus can cause bacteremia and fatal sepsis after animal bites,
especially in patients with asplenia or immunocompromising conditions. The
incubation period for C. canimorsus infection is one to three days.
o Bartonella henselae may be transmitted via the bite of an infected cat; other forms of
transmission include cat scratches and contact with cat saliva via broken skin or
mucosal surfaces. The incubation period for B. henselae infection is 7 to 14 days.
• Possum
o Francisella tularensis may be transmitted by bites/scratches and cause Tularaemia
disease. Symptoms develop day 3-5 and include are high fever, a skin ulcer at the site
of the bite or skin exposure, and swelling of the nearby lymph glands chills, fatigue,
general body aches, headache and nausea and develop.
• Macaque Monkeys
o Macacine alphaherpesvirus 1 transmitted by infected macaque monkeys can cause
severe CNS disease including encephalitis.
• Rats
o Rat bite fever (caused by Streptobacillus moniliformis or Spirillum minus) should be
considered in a child presenting with fever, rash and arthritis 4 to 10 days following a
rodent bite.
• Horses (not bite related)
o Hendra Virus is known to have infected 7 people after high levels of exposure to
infected horses. It should be considered in a child with a influenza-like illness 5 -21
days post exposure to a sick horse15
.
• Humans
o Clenched fist injuries (“fight bites”) are considered the most severe human bite injuries
and result from the patient striking another person’s teeth. They usually occur at the
metacarpophalangeal joints of the dominant hand of the patient. In these cases, there
is a higher risk for septic arthritis and osteomyelitis 2,6
.
o Human immunodeficiency virus (HIV) and Hepatitis B virus (HBV) can be transmitted
following a human bite10,11. (For elaboration see the CHQ-GDL-65664 Post-Exposure
Prophylaxis for HIV and contact the Public Health and the Infection Disease consultant
on service to discuss any suspected cases)
with a influenza-like illness 5 -21
days post exposure to a sick horse15
.
• Humans
o Clenched fist injuries (“fight bites”) are considered the most severe human bite injuries
and result from the patient striking another person’s teeth. They usually occur at the
metacarpophalangeal joints of the dominant hand of the patient. In these cases, there
is a higher risk for septic arthritis and osteomyelitis 2,6
.
o Human immunodeficiency virus (HIV) and Hepatitis B virus (HBV) can be transmitted
following a human bite10,11. (For elaboration see the CHQ-GDL-65664 Post-Exposure
Prophylaxis for HIV and contact the Public Health and the Infection Disease consultant
on service to discuss any suspected cases)
Complex bite wounds:
• Elevate injured extremity for the first 2-3 days.
• Significant hand wounds can benefit from 3-5 days of immobilisation.
• A fracture associated with a bite should be managed as a compound fracture with IV antibiotic
treatment and hospital/specialist referral.
Vaccinations/ postexposure prophylaxis:
• Rabies vaccine and postexposure prophylaxis (HRIG) should be administered to all bat
bites/scratches and children with a mammalian bite wound from a rabies endemic area
(including Indonesia/Bali).
o If the patient is vaccinated (documented), then rabies immunoglobulin (HRIG) is not required
however they should receive two additional doses of rabies vaccine. Contact Public Health
authorities for advice and access to rabies vaccine.
o No rabies postexposure prophylaxis should be administered to children bitten in Australia by
any animal other than a bat.
• Tetanus vaccination should be administered according to the Tetanus Prophylaxis in Wound
Management
• For human bites including clenched fist injuries consider hepatitis B if not immune and HIV
prophylaxis (if at high risk seek ID advice)
Antibiotic treatment:
Antibiotic therapy is not required if the wounds are small, not involving deeper structures and
present within 8 hours and can be adequately debrided and irrigated in the healthy individual.
Prophylactic treatment is indicated in wounds with high risk of infection that include:
• presentation to medical care is delayed by 8 hours or more
• the wound is a puncture wound that cannot be debrided adequately
• the wound is on the hands, feet or face
• the wound involves deeper tissues (eg bones, joints, tendons)
• the wound involves an open fracture
• the patient is immunocompromised (eg due to asplenia or immunosuppressive medications),
• the wound is a cat bite. 16, 20
o For empiric antibiotic recommendations, refer to the CHQ-GDL-01202 CHQ Paediatric
Antibiocard: Empirical Antibiotic Guidelines
▪ If water-related/immersed wound infection, also refer to CHQ-GDL-63000 Management
of Water-immersed Wound Infections in Children and contact Infection Management team
for advice.
▪ If open globe/penetrating eye injury, also refer to CHQ-GDL-01074 Acute
management of Open Globe Injuries (penetrating eye injury) and contact Ophthalmology
team for advice