Rat Bite Management

Immediate Wound Care

All rat bite wounds must be immediately and thoroughly washed with soap and water for at least 15 minutes, as this single intervention reduces infection risk more effectively than any other measure, according to the American College of Emergency Physicians 1
Irrigate copiously with sterile normal saline or water to remove debris and reduce bacterial load, as recommended by the American College of Emergency Physicians 2
Avoid closing infected wounds; non-infected wounds seen early (<8 hours) may be approximated with Steri-Strips rather than sutures, following guidelines from the American College of Emergency Physicians 2
Facial wounds are an exception and may be closed primarily after meticulous irrigation and prophylactic antibiotics, as suggested by the American College of Emergency Physicians 2

Administer tetanus toxoid (0.5 mL intramuscularly) if vaccination status is outdated or unknown, as recommended by the Centers for Disease Control and Prevention 2

Rabies prophylaxis is generally NOT required for rat bites in the United States, as small rodents (including rats) are not considered significant rabies vectors, according to the Centers for Disease Control and Prevention 3, 4
If rabies exposure is suspected in exceptional circumstances, previously unvaccinated persons should receive both rabies immune globulin (RIG) at 20 IU/kg and a 4-dose vaccine series on days 0, 3, 7, and 14, as recommended by the World Health Organization 1
The full RIG dose should be infiltrated around and into the wound if anatomically feasible, with remaining volume given intramuscularly at a site distant from vaccine administration, following guidelines from the World Health Organization 1

For infected rat bite wounds, amoxicillin-clavulanate is the first-line oral antibiotic therapy, providing broad coverage for the polymicrobial nature of these infections, as recommended by the Infectious Diseases Society of America 2
Oral alternatives for penicillin allergy include doxycycline, fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin) plus metronidazole or clindamycin, as suggested by the Infectious Diseases Society of America 2
Intravenous first-line therapy includes ampicillin-sulbactam or piperacillin-tazobactam, according to the Infectious Diseases Society of America 2
Intravenous alternatives include second-generation cephalosporins (cefoxitin) or carbapenems (ertapenem, imipenem, meropenem), as recommended by the Infectious Diseases Society of America 2

Elevate injured extremities if swollen, as recommended by the American College of Emergency Physicians 2
Follow up within 24 hours for all outpatients, according to the American College of Emergency Physicians 2
Consider hospitalization if infection progresses despite appropriate antimicrobial therapy, as suggested by the American College of Emergency Physicians 2
Ensure adequate wound irrigation, as this is more important than antibiotic prophylaxis, following guidelines from the American College of Emergency Physicians 1, 2