From the Guidelines
Dog and cat bites commonly lead to Pasteurella multocida infections, which require prompt treatment to prevent serious complications, and the standard treatment is amoxicillin-clavulanate (Augmentin) 875/125 mg twice daily for 5-7 days, as recommended by the Infectious Diseases Society of America 1.
Key Infection
The key infection associated with dog and cat bites is Pasteurella multocida, which can lead to serious complications if left untreated. Other common pathogens include streptococci, staphylococci, and anaerobes.
Treatment
The treatment of choice for dog and cat bites is amoxicillin-clavulanate (Augmentin) 875/125 mg twice daily for 5-7 days, which covers both Pasteurella species and other common oral flora like streptococci, staphylococci, and anaerobes 1. For penicillin-allergic patients, alternatives include doxycycline plus metronidazole, or a fluoroquinolone (ciprofloxacin or levofloxacin) plus clindamycin.
Observation Period
Close observation is required for 48-72 hours to monitor for signs of infection such as increasing pain, redness, swelling, or purulent discharge. This allows for early detection and treatment of any potential complications.
Prophylaxis
Prophylactic antibiotics are indicated for cat bites, hand injuries, facial wounds, deep punctures, immunocompromised patients, and wounds requiring surgical repair. Tetanus prophylaxis should also be considered, and post-exposure prophylaxis for rabies should be assessed based on the animal's vaccination status and behavior 1.
Some key points to consider when managing dog and cat bites include:
- Thoroughly cleaning the wound with soap and water, and irrigating with normal saline
- Avoiding suturing when possible
- Considering the need for a booster dose of tetanus vaccine
- Individualizing decisions regarding antibiotic prophylaxis and primary wound closure based on the exposing animal species, size and location of the wound(s), and time interval since the bite.
From the Research
Key Infection
- The most common complication following an animal bite is a wound infection, which tends to be polymicrobial and include both aerobic and anaerobic bacteria mainly of oropharyngeal origin 2.
- Pasteurella spp. predominates in infected dog and cat bites, with Capnocytophaga canimorsus also being a common cause of infection in dog bites 2, 3, 4.
- The likelihood of a cat bite becoming infected is double that of a dog bite 2.
Treatment
- Early aggressive local wound cleansing is the most important therapy to prevent infection after animal bites 2.
- Broad-spectrum antibiotics, covering both aerobic and anaerobic bacteria, are often recommended as empiric treatment of animal bites 2, 5.
- Amoxicillin/clavulanate is the first-line prophylactic antibiotic for animal bites 6.
Observation Period
- Patients with animal bites should be monitored for signs of infection, such as fever, abscess, and lymphangitis 5.
- The observation period for animal bites is not specified, but patients should be advised to seek medical attention if they experience any signs of infection.
Prophylaxis
- Antibiotic prophylaxis should be considered, especially if there is a high risk of infection, such as with cat bites, with puncture wounds, with wounds to the hand, and in persons who are immunosuppressed 6.
- Postexposure rabies prophylaxis consists of immune globulin at presentation and vaccination on days 0,3,7, and 14 6.
- Counseling patients and families about animal safety may help decrease animal bites 6.