From the Guidelines
If you've been bitten by a dog and the bite has broken the skin on your leg, you should seek medical attention and typically be prescribed antibiotics, with amoxicillin-clavulanate 875/125 mg twice daily being a commonly recommended option 1. When considering antibiotic treatment for dog bites, it's essential to prioritize coverage for a broad range of bacteria, including Pasteurella multocida, streptococci, staphylococci, and anaerobes.
- The recommended therapy for infections following animal bites, as outlined in the 2014 update by the Infectious Diseases Society of America 1, suggests amoxicillin-clavulanate as a first-line option due to its broad-spectrum activity.
- Alternative antibiotics, such as doxycycline or trimethoprim-sulfamethoxazole plus clindamycin, may be considered for patients with penicillin allergies or other specific needs 1.
- It's crucial to clean the wound thoroughly with soap and water, apply an antiseptic, and cover it with a clean bandage before starting antibiotic treatment.
- Monitoring for signs of infection, such as increasing redness, swelling, warmth, pus, or fever, is vital, and immediate medical attention should be sought if any of these symptoms occur.
- Additionally, ensuring up-to-date tetanus vaccination and considering rabies prophylaxis if the dog's vaccination status is unknown are important aspects of managing dog bite injuries.
From the Research
Dog Bite Infections and Antibiotic Treatment
- Dog bites can lead to infections, with the most prevalent organisms being Pasteurella, streptococci, staphylococci, and Fusobacterium, Bacteroides, and Porphyromonas species 2
- Infected wounds are polymicrobial in nature, and treatment includes thorough cleansing of the wound, with copious irrigation, as well as suitable antibiotics for the initial empiric and expectant therapy 2
Antibiotic Choices for Dog Bite Wounds
- 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 the first-line choice of antibiotic for dog bite wounds, especially for puncture wounds, moderate or severe bite wounds, or wounds sustained by victims who are immunocompromised or asplenic 3
Indications for Prophylactic Antibiotics
- Prophylactic antibiotics are indicated if the dog bite has undergone primary closure; if there is a moderate or severe bite wound; for puncture wounds (especially if penetration of bone, tendon sheath, or joint), facial bites, bites to the hands or feet, or genital area bites; or wounds sustained by victims who are immunocompromised or asplenic 3
- Puncture wounds or wounds closed during treatment are dog bite wounds at a high risk of infection and should be considered for treatment with prophylactic antibiotics 4
Current Practice and Guidelines
- Prophylactic antibiotics are extensively used for patients with dog bites, but there is scope to rationalise antibiotic use and route of antibiotic administration in patients with dog bites 5
- The incidence of infection in wounds that were not punctured or closed during treatment was only 2.6% (95% CI 0.7% to 6.5%), suggesting that not all dog bite wounds require prophylactic antibiotics 4