Case 39: Infected facial wound
Tuesday, January 10th, 2012Author: Dr Danielle Coleman
This 62yr old diabetic with epilepsy presented a week previously when she bit her lip in the course of a seizure. The wound was thoroughly cleaned, and sutured. She presented back to the ED with an obviously infected facial wound.
1. This wound was effectively a human bite. Should human bites get prophylactic antibiotics?
Click to see the answerIn general wounds to the face rarely become infected. However there are patient and wound factors that increase the risk of infection. Patient factors: diabetes, chronic renal failure, malnutrition, steroids, immunosuppressants, connective tissue disorders, elderly. Wound factors: presence of tissue destruction and wounds due to bites, particularly human bites.Patients with these factors should be considered for prophylactic antibiotics. In the case of human bites, a review of the use of antibiotics has been published as part of the Best Bets series: see link
2. Is a particular organism usually responsible for infection from human bites?
Click to see the answerNo. Human saliva contains both a large number and large range of organisms. Infections can include Staphylococcus, streptococci, anaerobes including bacteroides and peptostreptococcus, and the slow growing gram negative, Eikenella corrodens.
3. If antibiotics are indicated – which should be used?
Click to see the answerOptions include co-amoxiclav, doxycycline, and third generation cephalosporins.