What antibiotics (abx) are recommended for an infected dog bite on the hand?

From the Guidelines

For an infected dog bite of the hand, the recommended antibiotic treatment is amoxicillin-clavulanate (Augmentin) 875/125 mg orally twice daily for 5-7 days. This is the first-line therapy because dog bites typically introduce a mix of aerobic and anaerobic bacteria, including Pasteurella species, Streptococcus, Staphylococcus, and Capnocytophaga 1. The choice of amoxicillin-clavulanate is based on its broad-spectrum activity against the common pathogens involved in dog bites, as outlined in the guidelines for the diagnosis and management of skin and soft tissue infections 1.

Key Considerations

• For patients with penicillin allergies, alternatives include doxycycline 100 mg twice daily, or a combination of clindamycin 300-450 mg three times daily plus either trimethoprim-sulfamethoxazole or a fluoroquinolone 1.
• Hand infections from animal bites require prompt treatment as they can rapidly progress due to the hand's compartmentalized anatomy and limited soft tissue coverage.
• In addition to antibiotics, the wound should be thoroughly cleaned, irrigated with normal saline, and any devitalized tissue should be debrided 1.
• Elevation of the hand and close monitoring for signs of worsening infection are important.
• If there are signs of severe infection, spreading cellulitis, or involvement of joints or tendons, intravenous antibiotics and possible surgical intervention may be necessary.
• Tetanus prophylaxis should also be administered if the patient's immunization status is not up to date 1.

Management Principles

• Wounds should be cleansed with sterile normal saline and superficial debris removed 1.
• Infected wounds should not be closed, and deeper debridement is usually unnecessary but should be done cautiously if necessary.
• The use of a passive method for immobilization, such as a sling for outpatients, and ensuring tetanus prophylaxis is up to date are crucial aspects of management 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Antibiotic Treatment for Infected Dog Bite Wounds of the Hand

• The most prevalent organisms in infected dog bite wounds are Pasteurella, streptococci, staphylococci, and Fusobacterium, Bacteroides, and Porphyromonas species 2.
• Suitable antibiotics for the initial empiric and expectant therapy include amoxicillin-potassium clavulanate, a penicillin with a first generation cephalosporin, or clindamycin and a fluoroquinolone (eg, for patients allergic to penicillins) 2.
• Amoxicillin-clavulanate is recommended for the outpatient treatment of dog and cat bite wounds 3.
• Amoxicillin-clavulanic acid is an appropriate empirical antimicrobial choice for moderate dog bite wounds 4.
• The most commonly prescribed antimicrobials for dog bite wounds are amoxicillin-clavulanic acid and first-generation cephalosporins 5.

Predictors of Infection from Dog Bite Wounds

• Puncture wounds and wound closure are independent predictors of infection in dog bite wounds 6.
• The incidence of infection in wounds that are not punctured or closed during treatment is only 2.6% (95% CI 0.7% to 6.5%) 6.
• Dog bite wounds on the hand, especially those that are puncture wounds or closed during treatment, may benefit from prophylactic antibiotics to prevent infection 6.

Choice of Antibiotics

• Amoxicillin-clavulanic acid is a suitable choice for the treatment of dog bite wounds, including those on the hand 2, 3, 4, 5.
• The choice of antibiotic should be based on the severity of the wound, the presence of puncture wounds or wound closure, and the patient's allergy status 2, 6.