From the Guidelines
Antibiotics are strongly recommended for dog and cat bites due to the high risk of infection, with amoxicillin-clavulanate (Augmentin) being the first-line treatment, typically prescribed at 875/125 mg twice daily for adults or 45 mg/kg/day divided twice daily for children, for 5-7 days, as recommended by the Infectious Diseases Society of America 1.
Key Considerations
- The choice of antibiotic should be based on the type of bite, with amoxicillin-clavulanate being effective against a wide range of bacteria, including Pasteurella, Streptococcus, Staphylococcus, and anaerobes.
- For patients with penicillin allergies, alternatives include doxycycline 100 mg twice daily, trimethoprim-sulfamethoxazole plus clindamycin, or a fluoroquinolone plus clindamycin.
- Treatment should begin as soon as possible after the bite occurs, ideally within 24 hours, to reduce the risk of infection.
- In addition to antibiotics, proper wound cleaning, debridement of devitalized tissue, and tetanus prophylaxis should be considered.
Infection Risk
- Cat bites pose a particularly high infection risk (30-50%) due to their deep puncture wounds that inject bacteria deep into tissues.
- Dog bites (5-15% infection rate) often cause crushing injuries and lacerations, which can also lead to infection.
- Patients should monitor for increasing pain, redness, swelling, or drainage, which may indicate worsening infection requiring medical reevaluation.
Evidence-Based Recommendations
- The Infectious Diseases Society of America recommends amoxicillin-clavulanate as the first-line treatment for animal bites, based on its effectiveness against a wide range of bacteria 1.
- The guidelines also recommend considering the use of antibiotics active against MRSA in patients with carbuncles or abscesses who have failed initial antibiotic treatment or have markedly impaired host defenses or in patients with SIRS and hypotension 1.
From the Research
Antibiotic Treatment for Dog and Cat Bites
- Dog and cat bites can lead to serious infections, with Pasteurella multocida being a common cause of infection in both types of bites 2, 3, 4.
- Amoxicillin-clavulanate is recommended as the first-line antibiotic for the treatment of dog and cat bites due to its effectiveness against a wide range of bacteria, including Pasteurella multocida 2, 3, 4, 5, 6.
- The use of amoxicillin-clavulanate has been shown to be effective in preventing infection in dog and cat bites, particularly in high-risk cases such as cat bites, puncture wounds, and wounds to the hand 3, 4.
- Other antibiotics, such as enrofloxacin, may also be effective against certain bacteria that can cause infection in dog and cat bites, but their use should be guided by antimicrobial susceptibility patterns and the principles of antimicrobial stewardship 6.
Risk Factors for Infection
- Certain factors can increase the risk of infection from dog and cat bites, including:
- Cat bites, which have a higher risk of infection due to the deeper puncture wounds they can cause 2, 3, 4.
- Puncture wounds, which can be more prone to infection due to the difficulty of cleaning and irrigating the wound 3, 4.
- Wounds to the hand, which have a higher risk of infection due to the complexity of the anatomy and the potential for tendon or bone involvement 2, 3, 4.
- Immunocompromised individuals, who may be more susceptible to infection due to their weakened immune system 3, 4.
Management of Dog and Cat Bites
- Dog and cat bites should be managed promptly and appropriately to prevent infection and promote healing 2, 3, 4.
- This includes cleaning and irrigating the wound, exploring the wound for tendon or bone involvement and possible foreign bodies, and considering antibiotic prophylaxis in high-risk cases 3, 4.
- Tetanus immunization status and the risk of rabies infection should also be addressed in the management of dog and cat bites 2, 3, 4.