In which cases of human bites should I consider antibiotic prophylaxis, and what agents are recommended?

Antibiotic prophylaxis should be considered in cases of human bites that are at high risk of infection, such as bites on the hand, deep puncture wounds, or wounds that are heavily contaminated. These wounds have a higher likelihood of developing infection due to the complex flora of the human mouth and the potential for tissue damage.

Recommended antibiotic agents for prophylaxis typically include those effective against common oral flora, including aerobic and anaerobic bacteria. First-line agents often include amoxicillin-clavulanate due to its broad spectrum covering both aerobic and anaerobic organisms commonly found in human bite wounds.

In patients allergic to penicillin, alternatives such as doxycycline or a combination of clindamycin with a fluoroquinolone may be considered, depending on local guidelines and patient factors.

Antibiotic prophylaxis is particularly important in patients with increased risk of complications, such as those with diabetes, immunosuppression, or when the bite involves critical areas like the hands or face.