What is the proper management for a dog bite?

From the Guidelines

For a dog bite, immediate cleaning of the wound with soap and water for at least 5 minutes is essential, followed by application of an antiseptic like povidone-iodine, as recommended by the most recent guidelines 1. The management of dog bites requires careful consideration of the risk of infection, particularly from bacteria like Pasteurella, Staphylococcus, and Streptococcus commonly found in dog mouths.

• Control bleeding by applying direct pressure with a clean cloth.
• For minor bites, cover with a sterile bandage after cleaning.
• Seek medical attention promptly, especially for deep wounds, bites to the face, hands, or feet, or if the dog's vaccination status is unknown. A healthcare provider may prescribe antibiotics such as amoxicillin-clavulanate (875/125 mg twice daily for 5-7 days) to prevent infection, as suggested by the Infectious Diseases Society of America guidelines 1.
• Tetanus prophylaxis may be needed if your immunization is not current.
• Rabies post-exposure prophylaxis might be recommended depending on the circumstances. It is crucial to watch for signs of infection, including increasing pain, redness, swelling, warmth, or discharge from the wound, as dog bites can cause significant tissue damage and infection risk due to the crushing force of canine jaws and bacterial contamination 1. The decision to give “prophylactic” antibiotics should be based on wound severity and host immune competence, with some studies suggesting that prophylactic antibiotics may provide marginal benefit to wound care for patients with dog bites who present within 12–24 hours after injury, particularly in low-risk wounds 1.

From the Research

Dog Bite Management

• Dog bites are a common cause of non-fatal injuries, and proper management is crucial to prevent complications such as infection and systemic infections 2.
• The management of dog bites includes thorough cleansing of the wound with copious irrigation, and abscesses should undergo incision and drainage 2.
• Antibiotics such as amoxicillin-potassium clavulanate, a penicillin with a first-generation cephalosporin, or clindamycin and a fluoroquinolone may be used for initial empiric and expectant therapy 2.
• The choice of antibiotic is controversial, but initial empirical treatment generally relies on broad-spectrum coverage 3.
• Factors to consider when evaluating animal bites include the type of animal involved, the specific nature of the wound, circumstances of the attack, interval between injury and treatment, and location of the bite 3.

Prevention and Prophylaxis

• Preventive strategies should be aimed at public awareness of basic animal safety and responsible pet ownership 2.
• Rabies prophylaxis is indicated for bites by carnivorous wild animals, bats, and unvaccinated domestic animals 3, 4.
• Review of the patient's tetanus status is mandatory 3, 5.
• Antibiotic prophylaxis is controversial, but most authorities agree that it is needed for hand wounds, puncture wounds, or "dirty" wounds of any type in any location 3.

Treatment Outcomes

• A study found that amoxicillin-clavulanic acid is an appropriate empirical antimicrobial choice for moderate dog bite wounds, and reduced empirical enrofloxacin use can promote antimicrobial stewardship and potentially antimicrobial resistance 6.
• The study also found that over 90% of gram-negative and gram-positive isolates were susceptible to amoxicillin-clavulanic acid, and 96% of gram-negative and 86% of gram-positive isolates were susceptible to enrofloxacin 6.