What is the role of Augmentin (amoxicillin-clavulanate) in treating dog bites?

From the Guidelines

Augmentin (amoxicillin-clavulanate) is the recommended first-line antibiotic treatment for dog bites, with a typical adult dosage of 875 mg amoxicillin/125 mg clavulanate twice daily for 5-7 days. This recommendation is based on the guidelines for the diagnosis and management of skin and soft tissue infections, which suggest that amoxicillin-clavulanate is effective against the polymicrobial bacteria commonly found in dog bite wounds 1. The combination of amoxicillin and clavulanate provides broad-spectrum coverage against aerobic and anaerobic bacteria, including Pasteurella, Streptococcus, Staphylococcus, and various anaerobes.

Some key points to consider when treating dog bites with Augmentin include:

• Starting treatment as soon as possible after the bite, ideally within 8 hours, to prevent infection
• Using proper wound cleaning and debridement techniques to promote healing and reduce the risk of infection
• Considering tetanus prophylaxis, especially if the patient's tetanus vaccination is not up to date
• Monitoring for signs of worsening infection, such as increasing redness, swelling, pain, or fever, which would require prompt medical reevaluation

It's also important to note that patients with penicillin allergies may require alternative antibiotics, such as doxycycline or a fluoroquinolone plus clindamycin 1. Additionally, the bacteriology of dog bite wounds can be complex, and empirical therapy may not always cover all possible pathogens, highlighting the importance of clinical judgment and potential adjustment of treatment based on patient response and culture results.

From the FDA Drug Label

1.4 Skin and Skin Structure Infections – caused by beta-lactamase–producing isolates of Staphylococcus aureus, Escherichia coli, and Klebsiella species. The role of Augmentin (amoxicillin-clavulanate) in treating dog bites is to treat skin and skin structure infections caused by susceptible bacteria, such as Staphylococcus aureus, Escherichia coli, and Klebsiella species 2.

• Key points:
  • Augmentin is effective against beta-lactamase-producing isolates of certain bacteria.
  • It is used to treat skin and skin structure infections.
  • The drug's efficacy in treating dog bites is based on its ability to target susceptible bacteria that may be present in the wound.

From the Research

Dog Bite Treatment with Augmentin

• The use of Augmentin (amoxicillin-clavulanate) in treating dog bites is supported by its broad-spectrum antibacterial activity, coverage of beta-lactamase-producing pathogens, and a favourable pharmacokinetic/pharmacodynamic profile 3.
• However, the decision to use prophylactic antibiotics, including Augmentin, in dog bite wounds depends on various factors, such as the type of wound, location, and patient-specific criteria 4, 5, 6.
• Studies suggest that puncture wounds, hand wounds, and "dirty" wounds may benefit from prophylactic antibiotics, including Augmentin, to reduce the risk of infection 4, 5.
• The choice of antibiotic, including Augmentin, should be based on the severity of the wound, patient factors, and local resistance patterns 4, 6.
• While Augmentin is effective against a wide range of bacteria, its use should be guided by evidence-based guidelines and antimicrobial stewardship principles to minimize the risk of resistance and adverse effects 3, 6.

Wound Management and Antibiotic Prophylaxis

• Current literature suggests that primary closure of dog bites that are well irrigated and sharply debrided within 8 hours of injury is not associated with increased infection 7.
• Routine antibiotic prophylaxis in low-risk wounds does not lower the risk of infection, but may be considered for high-risk wounds, such as puncture wounds or wounds with significant tissue damage 7, 5.
• The use of prophylactic antibiotics, including Augmentin, should be balanced against the risks of antibiotic resistance, adverse effects, and financial costs 6.

Patient-Specific Criteria for Prophylactic Antibiotics

• Patient-specific criteria, such as immune status, wound location, and underlying medical conditions, should be considered when deciding whether to use prophylactic antibiotics, including Augmentin, in dog bite wounds 4, 5, 6.
• Further research is needed to inform safe practice and improve patient care, cost-effectiveness, and antimicrobial stewardship in the treatment of dog bites with prophylactic antibiotics, including Augmentin 6.