From the Guidelines
For high-risk dog bite prophylaxis from an orthopedic perspective, the recommended antibiotic regimen is amoxicillin-clavulanate (Augmentin) 875/125 mg orally twice daily for 3-5 days. This recommendation is based on the most recent and highest quality study available, which suggests that amoxicillin-clavulanate is effective in reducing the risk of infection in dog bite wounds 1. For patients with penicillin allergies, alternatives include doxycycline 100 mg twice daily, or a combination of clindamycin 300 mg three times daily plus either ciprofloxacin 500 mg twice daily or trimethoprim-sulfamethoxazole (TMP-SMX) double-strength twice daily.
Key Considerations
- High-risk bites warranting prophylaxis include those with:
- Puncture wounds
- Hand or foot involvement
- Wounds near joints or prosthetic implants
- Deep tissue injury
- Immunocompromised patients
- Wounds with significant crushing
- Prophylaxis should be started as soon as possible, ideally within 8 hours of injury
- These antibiotics target the polymicrobial nature of dog bite infections, which typically include Pasteurella species, streptococci, staphylococci, Capnocytophaga canimorsus, and anaerobes
Additional Management
- In addition to antibiotics, thorough wound irrigation, debridement of devitalized tissue, and appropriate tetanus prophylaxis are essential components of management
- For severe bites with deep tissue involvement or those near joints, orthopedic consultation is recommended to assess for joint penetration or tendon damage, as supported by previous guidelines 1
From the Research
Orthopedic Guidelines for Antibiotic Management in Dog Bites
- The management of dog bites involves thorough cleansing of the wound, with copious irrigation, and the use of suitable antibiotics for initial empiric and expectant therapy 2.
- Recommended antibiotics for prophylaxis in high-risk dog bites include amoxicillin-potassium clavulanate, a penicillin with a first-generation cephalosporin, or clindamycin and a fluoroquinolone (for patients allergic to penicillins) 2.
- Current literature suggests that primary closure of bites that are well irrigated and sharply debrided within 8 hours of injury is not associated with increased infection, and routine antibiotic prophylaxis in low-risk wounds does not lower the risk of infection 3.
- The use of prophylactic antibiotics is recommended in high-risk wounds, and the choice of antibiotic should be based on the severity and location of the bite, as well as the patient's individual factors 3, 4.
- In cases where osteomyelitis is suspected, antibiotics should be tailored based on culture results and individual patient factors, and surgical bony debridement may be necessary 5.
High-Risk Dog Bites
- High-risk dog bites include those that are deeply punctured, have a high risk of infection, or involve the hands, feet, or face 3, 4.
- In these cases, prophylactic antibiotics are recommended to reduce the risk of infection, and the choice of antibiotic should be based on the severity and location of the bite, as well as the patient's individual factors 3, 4.
Prevention of Infection
- Prevention of infection is crucial in the management of dog bites, and this can be achieved through thorough cleansing of the wound, copious irrigation, and the use of suitable antibiotics 2, 3, 4.
- Education of both children and parents on the risks of dog bites and the importance of supervising child-dog interactions is also essential in preventing dog bites 6.