Medical people: Question about punching someone in the face.

If you punched someone in the face and busted up your knuckles on their teeth, would an antibiotic shot be out of the question as a result, or would proper disinfectant be sufficient?

In case anyone is wondering, this is for my book. I’m not contemplating battery on someone.

Do you want the puncher to get an infection or not? Seems like the answer would vary depending on the desired outcome.

No, I don’t want the attacker to get infected. If a doctor were right there when the attack happened and had the supplies available, would (s)he offer an antibiotic shot, or would that just be silly? Basically, I want my doctor to act like a doctor and not like an unknowledgable writer’s version of a doctor.

If this is taking place today, I would almost definitely say no to the antibiotics. Doctors have grown very gun-shy about creating superbugs through the reckless application of antibiotics.

Twenty years ago, perhaps, depending on the doctor, but still probably not likely. Lord knows I took antibiotics every time I had a cold when I was young (my parents were in Pediatrics)–something that has happened only once since I left home, when I had strep throat.

Stick to the antiseptic, and to bacitracin/neosporin antibiotic OINTMENT beneath the bandage.

This is the opinion of a writer not a doctor, but…

I think it depends on the health of the punch victim. If the victim is a seemingly healthy person, anti-biotics would seem paranoid. Different story if the victim is infected with a known communicable disease.

Victims of human bites are reported to have higher rates of incidences of infections than victims of non-human bites.

A good cleaning should be sufficient though.

Try putting Qadgop the Mercotan or Dr. Paprika in your thread and see if they’ll find it no a vanity search.

FWIW, Their posts seem to be in the evening, (US times).

Might depend on the color of the teeth.

IANAMD but were I to read a scene involving someone who just punched someone else in the mouth cleaning his knuckles with an antiseptic I would not cast aside the book, leap to my feet and curse the author’s name for his inaccurate portrayal of mouth-punch aftermath.

But that’s just one man’s opinion.

Registered Nurse Cyn…

When my partner got bit by a woman, she washed the wound with anti-bacterial soap and water and put a water-resistant dressing on it and we went back to work. She didn’t get an infection. The doc didn’t suggest antibiotics, she was probobly too relieved this patient didn’t kick her in the head, not from lack of trying.

I would treat such an injury as a human bite. On one hand, it would probably not be as pentrating as many bites, but on the other hand, it would almost certainly involve the joints and tissues overlying them (where infections tend to be slower to heal, harder to manage, and more likelt to cause lasting injury). Human bites to the hand are the most likely to develop complications “Dog, cat, and human bites: a reviewJ Am Acad Dermatol. 1995 Dec;33(6):1019-29] says that human bites to the hand (including punch injuries) are the only human bites that are more likely to develop complications than any random mammal bite is.

There is not, as far as I know, any strong concensus on antibiotic prophylaxis in what are euphemistically termed “closed fist injuries”. In general, flushing and cleaning the wound, then bandaging it would be adequate, absent some specific indication for antibiotics,

A doctor wouldn’t really be wrong to go either way. It’s a judgment call after assessing of the wound, the patient’s history and condition, and other factors. Terrible dental hygiene might be a factor to consider, but it’d be a minor one. There are plenty of bugs in a normal mouth.

If the ‘punchee’ had (e.g.) the plague, I’d feel obligated to prescribe doxycycline, but that’s not the same as broad spectrum prophylaxis. If I knew the punchee had HIV, I’d refer the puncher for HIV prophylaxis/ counseling, but no antibiotics (or other drugs I might have with me) would help.

I’d consider if the patient was immunocompromised, had a condition that affects peripheral circulation or healing (e.g. cancer or lack of a spleen), if the wound was clean cut or a (hard to clean) crush injury, etc. You get the idea, it’s pretty much common sense.

I think this CME article (Continuing Medical Education) written for physicians assistants would be pretty clear to most laymen. If you want more info try including “human bites” in your search.

This is not medical advice. I am not your doctor. I’m also not your mommy, but I will suggest that you quit punching people anyway (if practical).

Thank you so much for all your help, everyone.

And don’t worry, KP. I’ve never hit anyone in my life, and I doubt I ever will.

That happened to me. Before you all climb on my back, let me just say that the “punchee” was a moron on angel dust that was assaulting everyone in reach. I tried backing away while warning him to knock it off, but he didn’t stop. I had backed up to the couch and couldn’t go any further.

One punch. Lights out.

His incisors left a gash on my middle finger. I rinsed it with water. Evidently, I should’ve done more. The resulting infection was spectacular in color, extent, and result. Over the next few days, my finger turned red, then crimson. My hand puffed up to twice it’s size, and I ended up losing a couple of fingernails.

I did go to the doctor, and got some antibiotics–I don’t remember which. They seemed to work.

It did majorly suck for a while, though.

Human bites are bad news. They tend to get infected very easily – and most doctors consider them worse than cat or dog bites. You see them commonly in siblings of young kids as well as folks who punch someone else in the mouth.

Treatment, if seen acutely, is to thoroughly wash out the wound with disinfectant under pressure – I fill a syringe with chlorohexidine and squirt it into each wound four or five times. Just dabbing it with Polysporin still causes infection since puncture wounds caused by any bite can be quite deep and it is important to clean to the “apex” of the wound (hence the syringe).

These infections turn nasty quick. I always prescribe an antibiotic for human bites, usually cloxacillin or amoxicillin with clavulinic acid.

In summary, human bites are bad news. They do need antibiotic treatment. Many of the clods who get in bar fights wait four days before seeking attention, having learned this the hard way.

(I just saw this. I don’t do vanity searches.)

Thanks so much, Dr_Paprika! I’m going to rewrite the scene first thing tomorrow. May have the doctor in question mention a potential loss of fingernails if left untreated, too.

“The use of topical antibiotics…is seldom warranted…[A]llergic contact dermatitis from topical antibiotics, especially neomycin, may complicate the primary problem.”

–The Merck Manual of Diagnosis and Therapy, 15th ed.

Either wash and bandage, or wash, bandage and systemic antibiotics.

This is not specific medical advice–consult a physician if injured.

Yea, you might not, but some people would. If it got popular enough, we’d have a thread in GQ (“Do You Use An Anti-Septic After You Punch Someone In The Mouth?”), three in CS (“Errors in the Mouth Punching Book!”), and 2 in the Pit (I HATED that book! The portrayal of mouth punching was soooooooooo inaccurate!).

Far better to stop it now…