What is the recommended intravenous (IV) antibiotic (ABX) selection for prophylaxis after a dog bite?

From the Guidelines

For prophylaxis after a dog bite, the recommended intravenous (IV) antibiotic selection is Ampicillin-Sulbactam 1.5–3.0 g every 6–8 h, as it provides broad-spectrum coverage against the most common pathogens associated with dog bites, including Pasteurella, Streptococcus, Staphylococcus, and anaerobic bacteria 1. This recommendation is based on the guidelines for the diagnosis and management of skin and soft tissue infections, which suggest that ampicillin-sulbactam is an effective option for the treatment of animal bites, including dog bites 1. Some key points to consider when selecting an antibiotic for prophylaxis after a dog bite include:

• The severity of the wound and the host's immune competence 1
• The risk of infection, which is higher for deep puncture wounds, bites to the hand, foot, face, or genital area, and bites in immunocompromised patients 1
• The need for broad-spectrum coverage, as dog bites can be caused by a variety of pathogens, including aerobic and anaerobic bacteria 1 Other options for IV antibiotic prophylaxis after a dog bite include:
• Piperacillin-Tazobactam 3.37 g every 6–8 h, which provides broad-spectrum coverage against many pathogens, but may not be effective against MRSA 1
• Doxycycline 100 mg every 12 h, which is effective against Pasteurella multocida, but may not provide adequate coverage against other pathogens 1
• Clindamycin 600 mg every 6–8 h, which is effective against staphylococci, streptococci, and anaerobes, but may not provide adequate coverage against Pasteurella multocida 1 It's essential to note that the decision to give prophylactic antibiotics should be based on the individual patient's risk factors and the severity of the wound, and that not all dog bites require antibiotic prophylaxis 1.

From the Research

Recommended IV Antibiotic Selection for Prophylaxis after a Dog Bite

• The most frequently isolated species from dog bites are Capnocytophaga canimorsus and Pasteurella multocida 2
• The use of prophylactic antibiotics may be useful to reduce the risk of developing a wound infection, especially in high-risk cases such as bites to the hand or in individuals with comorbidities 2, 3
• There is no evidence that the use of prophylactic antibiotics is effective for all dog bites, but it may be considered for high-risk cases 3, 4
• The Infectious Diseases Society of America recommends 3-5 days of antibiotic prophylaxis for high-risk dog bites 4
• The overall infection rate for pediatric dog bite injuries was 5.2%, and no difference in infection rates was found between those receiving and not receiving antibiotic prophylaxis in one study 4

Factors Influencing Antibiotic Prophylaxis

• Risk factors for infection after a dog bite include the presence of comorbidities, bites to the hand, and signs of alteration of the general state of the bitten individual 2
• The type of wound, such as laceration or puncture, does not appear to influence the effectiveness of prophylactic antibiotics 3
• The use of antibiotics is only recommended for high-risk bite wounds, and early surgical evaluation must be performed if the wound requires it 5