From the Guidelines
Animal bite wounds should generally not be sutured due to the high risk of infection, except in specific circumstances, such as facial wounds, wounds less than 6-8 hours old, or wounds that can be thoroughly cleaned and debrided, as recommended by the Infectious Diseases Society of America in 2014 1. When considering suturing an animal bite, the following factors should be taken into account:
- The type and location of the wound
- The time interval since the bite
- The ability to thoroughly clean and debride the wound
- The risk of infection and the need for prophylactic antibiotics Before suturing, the wound should be extensively irrigated with normal saline or sterile water under pressure, and all devitalized tissue should be debrided. Prophylactic antibiotics are essential, with amoxicillin-clavulanate being the first-line choice for 3-5 days, as recommended by the Infectious Diseases Society of America in 2014 1. For penicillin-allergic patients, alternatives include doxycycline, trimethoprim-sulfamethoxazole plus clindamycin, or a fluoroquinolone plus clindamycin. When suturing is performed, loose, simple interrupted sutures should be used to allow for drainage, and the wound should be reassessed within 24-48 hours. Tetanus prophylaxis should be administered if needed, and rabies risk should be evaluated, particularly for wild animal or unprovoked bites, as recommended by the Advisory Committee on Immunization Practices in 2008 1. The high infection risk with animal bites is due to the polymicrobial nature of animal oral flora, including Pasteurella, Streptococcus, Staphylococcus, and anaerobes, which can cause rapid infection when trapped in closed wounds. It is also important to note that the bacteriology of these wounds can differentiate the number of isolates per wound and whether additional coverage for anaerobes is required, as discussed in the 2014 update by the Infectious Diseases Society of America 1.
From the Research
Guidelines for Suturing an Animal Bite
- The decision to suture an animal bite wound should be made on a case-by-case basis, considering factors such as the location and size of the wound, the time elapsed since the bite, and the patient's overall health 2, 3.
- Dog bite injuries are most prevalent in younger patients, and Pasteurella species are frequently implicated in infections resulting from dog and cat bite injuries 2.
- All animal bite wounds should be washed out, and most can be managed in an outpatient setting 2.
- Primary suturing of dog bite wounds can result in improved cosmetic appearance, but the infection rate is similar to non-suturing 3.
- Time of management is critical, with early treatment resulting in lower infection rates and improved cosmetic appearance, regardless of whether the wound is sutured or not 3.
- The use of antibiotics in animal bite wounds is recommended in high-risk cases, with amoxicillin-clavulanic acid being a commonly used and effective option 4, 5.
- However, a significant proportion of patients may receive inadequate or unnecessary antibiotic prescriptions, highlighting the need for careful consideration of antibiotic use in animal bite wounds 4.
Considerations for Suturing
- The location of the wound is an important consideration, with wounds on the head and neck exhibiting better results in terms of infection rate and cosmetic outcome 3.
- The size of the wound is also a factor, with larger wounds (>3 cm) potentially affecting the cosmetic appearance of the outcome 3.
- The patient's age and overall health should also be taken into account when deciding whether to suture an animal bite wound 3.
Antibiotic Use
- Antibiotics should be used judiciously in animal bite wounds, with consideration given to the type of animal, the location and size of the wound, and the patient's overall health 4, 5.
- Amoxicillin-clavulanic acid is a commonly recommended antibiotic for animal bite wounds, due to its broad spectrum of activity and effectiveness against common pathogens such as Pasteurella species 4, 5.