LARGE ANIMAL ATTACKS - Medicine for Mountaineering and Other Wilderness Activities - page 483

Bacteria almost always heavily contaminate animal bite wounds. Lacerations and punc-
turewoundsmustbecarefullyexplored,debrided,andvigorouslyirrigatedwithdisinfected
water.Foreignmaterialisoftenintroducedbyanimalwoundsandmustbecarefullysought.
Only after thorough cleaning can wounds be dressed and splinted.
High-riskwounds,includingwoundsofindividualswhoareimmunocompromised,con-
stitute dangerous situations. Such wounds should be sutured only by experienced physi-
cians.
Hand wounds are common because the hands are used to defend against the attacking
animal.Suchwoundsdeservespecialconsiderationbecausethestructuresareanatomically
complex and hand function is so much a part of day-to-day activities.
Puncture wounds are common in bites and must be appropriately treated.
Everyone bitten by a wild animal should be offered postexposure rabies therapy
( Chapter 32: Rabies ) . Tetanus immunization should be administered if the individual has
not had a booster within five years.
Antibiotic therapy is particularly significant following an animal bite because the
wounds are so contaminated. The organisms typically found in bite wounds are specific to
the source:
◆ Bears—Micrococcus and Streptococcus
◆ Cats—Pasteurella and Pseudomonas
◆ Ungulates—Pasteurella and Acinetobacillus
◆ Crocodiles—Aeromonas
If possible, antibiotic therapy should be directed toward the specific pathogens associ-
ated with the attacking animal species. Otherwise, broadspectrum antibiotics should be ad-
ministered. Amoxicillin/clavulanate (Augmentin®) is probably the drug of choice in most
cases. A cephalosporin with metronidazole, clindamycin and doxycycline, gatifloxacin, or
moxifloxacin are other alternatives.