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Home > Patients and Visitors > Find Health and Wellness Programmes > Health Articles > Mammal Bites & Scratches: A Management Guide for Clinicians
NOBITE/SCRATCHES IN SINGAPORE (RABIES-FREE)WOUND CAREANTIBIOTICSTETANUS POST-EXPOSURE PROPHYLAXIS (PEP)RABIES POST-EXPOSURE PROPHYLAXIS (RPEP)HERPES SIMIAE POST-EXPOSURE PROPHYLAXIS (PEP)
1Dog Assess, irrigate, try not to sutureCan consider if infection is a concern (eg Augmentin for Staph, strep, oral anerobes, Pasteurella)Give Td or Tdap if none in past 10 yearsGenerally not recommendedNot required
2Cat Assess, irrigate, try not to sutureCan consider if infection is a concern (eg Augmentin for Staph, Bartonella, Pasteurella, anerobes)Give Td or Tdap if none in past 10 yearsGenerally not recommendedNot required
3MonkeyAssess, irrigate, try not to sutureCan consider if infection is a concern (eg Augmentin for Staph, strep, oral anerobes) Give Td or Tdap if none in past 10 yearsGenerally not recommendedValacyclovir 1gm po q8h x 2 weeks; OR Acyclovir 800 mg po 5x/day x 2 weeks
4BatAssess, irrigate, try not to sutureCan consider if infection is a concern (eg Augmentin for Staph, strep, oral anerobes) Give Td or Tdap if none in past 10 yearsRPEP usually recommendedNot required
5Bites by other mammalsAssess, irrigate, try not to sutureCan consider if infection is a concern (eg Augmentin for Staph, anerobes, specific pathogens) Give Td or Tdap if none in past 10 yearsNot requiredNot required

When to Refer to Emergency Department

  1. Need for Rabies PEP (for any mammal bite occurring in a rabies-endemic country, ie most countries in Asia, Africa, S.America)
    • Persons who never had rabies vaccine before the bite usually require rabies vaccines AND rabies immunoglobulin (RIG)– refer to ED
    • Persons with ≥ 3 rabies vaccine doses BEFORE the bite only need rabies vaccines– refer to THVC
    • If not sure, refer to ED
  2. Bite wound is deep, looks infected, or fever (T>38C)
  3. Severe wound that requires surgical repair
  4. Infections that require surgical drainage including tenosynovitis, abscess
  5. Bite wounds with toxic venoms eg. slow loris

When to Refer to Travellers’ Health & Vaccination Clinic

  1. Follow up rabies vaccine doses, after RIG is given in ED
  2. Initial evaluation of animal bite if patient not willing to go to ED
  3. Animal bite in Singapore where RPEP is not indicated but patient is still anxious and wants to see a ID/vaccine specialist

Emailthvc@ttsh.com.sgPhone: 6357-2222

Prepared by A/Prof Lim Poh Lian (Head, Travellers’ Health & Vaccination Clinic, IIDE, Tan Tock Seng Hospital.

















2019/01/11
Last Updated on