RAT BITE — CLINICIAN HANDOUT

                                                   

Patient: __________ DOB/Age: __________ MRN: __________ Date/Time: __________
Bite: ☐ Rat ☐ Other rodent: __________ Provoked? ☐ Yes ☐ No Domestic/pet vs wild: __________
Time since bite: __________ h/d Location: ☐ Hand ☐ Wrist/forearm ☐ Face ☐ Foot ☐ Other: __________
Comorbids (higher risk): ☐ Diabetes ☐ Immunosuppression ☐ Asplenia ☐ Cirrhosis ☐ Vascular insufficiency ☐ Other: __________
Allergies: __________ (reaction: __________)

1) Immediate assessment

• Vitals: T ___ HR ___ RR ___ BP ___ SpO₂ ___ Temp ___
• Red flags requiring urgent escalation/consult/admit:
  ☐ Uncontrolled bleeding ☐ Rapidly progressive swelling/pain ☐ Systemic toxicity ☐ Suspected deep-space hand infection
  ☐ Neurovascular compromise ☐ Suspected tendon/joint/bone involvement ☐ Necrosis/crepitus

2) Wound exam (document)

• Type: ☐ Puncture ☐ Laceration ☐ Crush ☐ Avulsion
• Depth/structures: ☐ Superficial ☐ Deep to fascia ☐ Tendon concern ☐ Joint capsule concern ☐ Bone exposed/seen
• Contamination/foreign body: ☐ None ☐ Dirt/debris ☐ Tooth/foreign body suspected
• Neurovascular/tendon function distal to wound: ☐ Intact ☐ Abnormal (details): __________

3) Wound care (do now)

• ☐ Copious irrigation (NS; high volume)
• ☐ Remove visible debris/foreign material; debride devitalized tissue as needed
• ☐ Analgesia (local/regional/systemic)
• ☐ Consider splint/elevation if hand/wrist involvement
• Primary closure? ☐ No (preferred for puncture/crush/hand/delayed/contaminated) ☐ Yes (criteria met; cosmetically/functional)
  If closed: method __________; follow-up arranged ☐ 24–48 h

4) Imaging / procedures / consult

• X-ray ☐ Yes ☐ No
  Indication: ☐ Foreign body ☐ Fracture ☐ Near joint ☐ Crush injury ☐ Other: __________
• Consult ☐ Hand/ortho ☐ Plastics ☐ ID ☐ Other: __________
  Reason: __________

5) Antibiotics (bite-wound prophylaxis vs treatment)

Use antibiotics for established infection (erythema, warmth, swelling, purulence, lymphangitis, fever) and consider prophylaxis for higher-risk wounds (e.g., hand, deep puncture/crush, devitalized tissue/contamination, suspected joint/bone/tendon involvement, poor circulation, immunocompromise). ⁽²⁾

• No skin break: ☐ No antibiotics
• Broken skin: prophylaxis indicated? ☐ Yes ☐ No
  Rationale (check): ☐ Hand/face/genitals ☐ Deep puncture/crush ☐ Delayed presentation ☐ Comorbidity risk ☐ Other: ______
• Signs of infection present? ☐ Yes ☐ No
• Regimen chosen:
  ☐ Amoxicillin–clavulanate __________ dose __________ route __________ duration __________
  ☐ Penicillin allergy alternative per local guideline: __________________ duration __________
  Notes: If a penicillin allergy is present and doxycycline-based regimens are being used, add anaerobic coverage as per local protocol where appropriate. ⁽³⁾

6) Rat-bite fever (RBF) screen (don’t miss)

RBF can present after rodent exposure with fever, rash, and arthralgia and may rarely lead to invasive disease (e.g., endocarditis); consider if systemic symptoms occur days–weeks after exposure.

• Symptoms now or since bite: ☐ Fever ☐ Rigors ☐ Rash (palms/soles/extremities) ☐ Migratory arthralgia/arthritis ☐ Vomiting/HA
• If suspected RBF:
  ☐ Blood cultures before antibiotics (if feasible)
  ☐ Evaluate for complications as indicated (cardiac exam ± echo if endocarditis concern)
  ☐ Treat as systemic infection per local/ID guidance (often IV beta-lactam or ceftriaxone; doxycycline is a common alternative in beta-lactam allergy)

7) Tetanus prophylaxis (always document)

• Wound category: ☐ Clean/minor ☐ Dirty/major (puncture, devitalized tissue, contaminated)
• Tetanus vaccine status:
  Last Td/Tdap: __________ Primary series complete? ☐ Yes ☐ No/Unknown
• Action:
  ☐ No vaccine needed
  ☐ Td/Tdap booster given today
  ☐ Tetanus immune globulin (TIG) given (if indicated)
  (Antibiotics are not used to prevent tetanus.) ⁽⁴⁾

8) Rabies risk documentation (usually low for rats)

• Animal available for assessment? ☐ Yes ☐ No
• Unusual circumstance (neurologic behavior / local outbreak / public health advice)? ☐ Yes ☐ No
• Plan: ☐ No rabies PEP indicated ☐ Public health consulted: __________ ☐ PEP started
  (If PEP is indicated: start with wound cleansing; HRIG + vaccine schedule per guidance.) ⁽¹⁾

9) Disposition & follow-up

• Disposition: ☐ Home ☐ Observation ☐ Admit (service: __________)
• Follow-up arranged: ☐ 24–48 h (hand/deep/closed/high risk) ☐ 3–5 d ☐ Other: __________
• Return precautions documented (clinician): worsening pain/swelling/erythema, purulence, fever, lymphangitis, reduced ROM, numbness/weakness, or systemic symptoms within 1–3 weeks (RBF concern).

If you tell me your local formulary preferences (or country/health system) and whether you want adult-only vs adult+peds, I can “lock” the antibiotic lines into exact doses/durations for your setting and keep it to a strict single page.

CITED SOURCES

1. Rabies Post-exposure Prophylaxis Guidance | Rabies | CDC. www.cdc.gov
2. Management of bites, human and animal - South & West.  southwest.devonformularyguidance.nhs.uk
3. Human and animal bites | Right Decisions.
   www.rightdecisions.scot.nhs.uk