An Unexpected Fish BiteBerkowitz, Tal MD, MPH; Goldsmith, Michael Paul MDPediatric Emergency Care: April 2017 - Volume 33 - Issue 4 - p 258–259 doi: 10.1097/PEC.0000000000000692 Illustrative Cases Abstract Author Information We report a case of a 22-month-old boy who suffered a piranha bite, amputating his fourth distal phalanx. His finger was irrigated and closed with a flap under sedation, but we could find little evidence during a brief literature search of what prophylactic antibiotics, if any, to provide. Because reports of infections from piranha bites are lacking, we examined studies evaluating oral flora from fish, as well as flora cultured from aquariums. In conclusion, if infection is present or prophylaxis is strongly desired, a broad spectrum oral antibiotic that covers Gram-positive and Gram-negative bacteria including Pseudomonas and Aeromonas species, such as ciprofloxacin, would be recommended; however, there is little evidence to suggest that prophylactic antibiotics provide benefit over appropriate wound management. From the *Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, GA; and †Pediatric Cardiology, Harvard University School of Medicine, Boston, MA. Disclosure: The authors declare no conflict of interest. Reprints: Tal Berkowitz, MD, MPH, Emory University Atlanta, GA (e-mail: email@example.com). Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.