Will ceftriaxone (Antibiotic, ABX) be effective as the first dose of antibiotics for treating a dog bite?

From the Guidelines

Ceftriaxone is not the first-choice antibiotic for treating dog bites, and amoxicillin-clavulanate is preferred due to its broader coverage of polymicrobial infections, including Pasteurella species, Streptococci, Staphylococci, and Capnocytophaga canimorsus. For dog bite wounds, the preferred initial antibiotic therapy is usually amoxicillin-clavulanate (Augmentin) at a dose of 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 for dog bite management include:
  • Proper wound cleaning and debridement if necessary
  • Tetanus prophylaxis
  • Assessment of rabies risk based on the circumstances of the bite and local prevalence
• If ceftriaxone must be used, such as in cases of penicillin allergy or unavailability of first-line options, it should ideally be combined with metronidazole to ensure adequate anaerobic coverage, with a typical ceftriaxone dose of 1-2 grams IV or IM daily 1.
• The choice of antibiotic should be guided by the severity of the wound, host immune competence, and local antimicrobial resistance patterns, with amoxicillin-clavulanate being a suitable option for most cases, as supported by studies 1.

From the FDA Drug Label

Ceftriaxone for Injection is indicated for the treatment of the following infections when caused by susceptible organisms: SKIN AND SKIN STRUCTURE INFECTIONS Caused by Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pyogenes, Viridans group streptococci, Escherichia coli, Enterobacter cloacae, Klebsiella oxytoca, Klebsiella pneumoniae, Proteus mirabilis, Morganella morganii, Pseudomonas aeruginosa, Serratia marcescens, Acinetobacter calcoaceticus, Bacteroides fragilis or Peptostreptococcus species

Ceftriaxone may be used to treat skin and skin structure infections caused by susceptible organisms.

• A dog bite can lead to a skin and skin structure infection.
• The first dose of antibiotics, in this case, ceftriaxone, may be appropriate for the treatment of a dog bite if the causative organism is susceptible to ceftriaxone 2. However, the specific use of ceftriaxone for a dog bite is not explicitly stated in the label. It is essential to consider the susceptibility of the causative organism and local epidemiology when selecting empiric therapy.

From the Research

Ceftriaxone Effectiveness for Dog Bites

• Ceftriaxone is a broad-spectrum antibiotic that may be effective against some bacteria commonly found in dog bite wounds, such as Staphylococcus intermedius, Enterococcus spp., and Escherichia coli 3.
• However, the effectiveness of ceftriaxone against all bacteria that may be present in dog bite wounds is not guaranteed, as no single antibiotic or combination of antibiotics is effective against all bacteria that may be cultured from these wounds 3.
• The use of antibiotic prophylaxis, including ceftriaxone, may be considered for certain types of dog bites, such as puncture wounds or wounds that are at high risk of infection 4, 5.
• Ceftriaxone has been shown to be effective against certain strains of bacteria, including pneumococci, with MIC90s of ≤ 0.064,1.0, and 2.0 micrograms/ml for susceptible, intermediately resistant, and resistant strains, respectively 6.

Factors to Consider for Antibiotic Prophylaxis

• The decision to use antibiotic prophylaxis, including ceftriaxone, should be based on factors such as the type and severity of the wound, the location of the bite, and the patient's overall health status 4, 5.
• Puncture wounds and wounds that are closed during treatment may be at higher risk of infection and may benefit from prophylactic antibiotics, including ceftriaxone 5.
• The patient's tetanus status and the risk of rabies transmission should also be considered when evaluating the need for antibiotic prophylaxis 4, 7.