From the Research
Prophylactic antibiotics are not routinely recommended for a patient who was only licked in the face by a dog that died from leptospirosis. Leptospirosis is primarily transmitted through contact with water, soil, or food contaminated with the urine of infected animals, or through direct contact with the infected animal's urine or tissues. The bacteria typically enter the body through cuts or abrasions in the skin or through mucous membranes of the eyes, nose, or mouth. While theoretically possible, transmission through a dog's saliva alone is considered very low risk, especially if the skin was intact and there were no open wounds on the face.
Key Considerations
- If the patient is concerned or if there were any cuts or open wounds on the face where the dog licked, they should wash the area thoroughly with soap and water and monitor for symptoms such as fever, headache, muscle aches, jaundice, or red eyes within the next 2-30 days.
- If symptoms develop, they should seek medical attention immediately and inform healthcare providers about the exposure.
- In high-risk cases or if the patient is immunocompromised, doxycycline 100mg twice daily for 7 days could be considered, but this is not standard practice for a lick exposure alone without additional risk factors, as supported by the most recent and highest quality study 1.
Evidence Summary
The most recent and highest quality study on antibiotic prophylaxis for leptospirosis, published in 2024 1, found that the certainty of evidence for the use of antibiotics in preventing leptospirosis is low or very low, and therefore, it is unclear if antibiotics have a significant effect on preventing the disease.
Clinical Decision
Given the low risk of transmission through a dog's saliva and the lack of strong evidence supporting the use of prophylactic antibiotics in this scenario, the patient does not need prophylactic antibiotics unless they have additional risk factors or are immunocompromised, in which case doxycycline could be considered 1.