What is the management for a dog bite to the external ear?

From the Guidelines

Management of a dog bite to the external ear requires immediate cleaning with soap and water, followed by irrigation with normal saline to remove debris and bacteria, and antibiotic prophylaxis with amoxicillin-clavulanate 875/125 mg twice daily for 5-7 days to cover common pathogens including Pasteurella, Staphylococcus, and anaerobes 1. The wound should be assessed for tissue damage, cartilage exposure, and vascular compromise.

• Tetanus prophylaxis should be administered if the patient's immunization status is incomplete or unknown.
• Pain management with acetaminophen or NSAIDs is appropriate.
• The wound may require primary closure if clean and presenting within 12 hours, though some wounds may heal better by secondary intention.
• Rabies risk should be assessed, with post-exposure prophylaxis considered based on the dog's vaccination status and circumstances of the bite 1.
• Follow-up within 48-72 hours is important to monitor for infection, which may present as increasing pain, redness, swelling, or purulent drainage.
• Ear cartilage involvement requires more aggressive management, possibly including IV antibiotics and surgical consultation, as cartilage infections (perichondritis) can lead to significant deformity if not properly treated. The decision to administer oral or parenteral antibiotics depends on the depth and severity of the wound and on the time since the bite 1.
• Antibiotic therapy should be based on the most likely pathogens, with amoxicillin-clavulanate being a suitable choice for dog bites.
• The use of antibiotic prophylaxis should be individualized based on the wound severity and host immune competence 1.

From the Research

Management of Dog Bites to the External Ear

The management of dog bites to the external ear involves several key steps to prevent infection and promote healing.

• Examination and cleaning of the wound: The wound should be examined, cleaned, and irrigated with warm water or normal saline solution to remove any foreign bodies and devitalized tissue 2.
• Antibiotic prophylaxis: Antibiotic prophylaxis, with amoxicillin/clavulanate as the first-line choice, should be considered for all bites, particularly for those at increased risk of infection 2, 3, 4.
• Assessment of neurovascular function: Neurovascular function (e.g., pulses, sensation) and range and movement of adjacent joints should be examined and documented 2.
• Tetanus vaccination and rabies postexposure prophylaxis: The need for tetanus vaccination and rabies postexposure prophylaxis should be evaluated for each patient; bites that do not break the skin generally do not require rabies postexposure prophylaxis 2, 5, 4.
• Imaging and laboratory studies: Imaging and laboratory studies are usually not required unless there is suspicion of a retained foreign body, damage to underlying structures, infection, or extensive injury 2.

Prevention of Infection

Prevention of infection is a critical aspect of managing dog bites to the external ear.

• Immediate copious irrigation can significantly decrease the risk of infection 5.
• Prophylactic antibiotics can reduce the incidence of infection in patients with dog bite wounds, particularly for those with wounds that are at high risk for infection 6.
• The use of amoxicillin-clavulanate is recommended for the outpatient treatment of dog bite wounds 4.

Documentation and Education

• The dog bite injury should be documented with photographs and diagrams when appropriate 5.
• Family physicians should educate parents and children on ways to prevent dog bites 5.