What antibiotics are recommended for a fracture resulting from a dog bite?

From the Guidelines

For a fracture resulting from a dog bite, the recommended antibiotic regimen typically includes amoxicillin-clavulanate (Augmentin) as the first-line treatment, usually at a dose of 875/125 mg twice daily for adults for 5-7 days, though treatment may extend to 14 days depending on the severity of the injury. This recommendation is based on the guidelines provided by the Infectious Diseases Society of America, as outlined in the 2014 update for the diagnosis and management of skin and soft tissue infections 1. The choice of amoxicillin-clavulanate is due to its effectiveness against the polymicrobial nature of dog bite infections, which often contain both aerobic bacteria (like Pasteurella, Streptococcus, and Staphylococcus) and anaerobic organisms.

Key considerations for the management of dog bite fractures include:

• The high risk of infection, which necessitates immediate prophylactic antibiotic treatment
• The potential need for longer treatment durations due to the complexity of the injury
• The importance of surgical intervention for proper wound cleaning, fracture stabilization, and removal of devitalized tissue
• The need for tetanus prophylaxis if the patient's immunization status is not up to date
• The consideration of rabies prophylaxis depending on the circumstances of the bite and the dog's vaccination status

For patients with penicillin allergies, alternative antibiotic regimens may be considered, such as:

• Doxycycline (100 mg twice daily)
• Trimethoprim-sulfamethoxazole plus clindamycin
• A fluoroquinolone (such as ciprofloxacin) plus clindamycin These alternatives are based on the antimicrobial coverage needed for the common pathogens involved in dog bite infections, as outlined in the guidelines 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Antibiotic Recommendations for Fractures from Dog Bites

• The use of broad-spectrum antibiotics such as amoxicillin-clavulanate and/or moxifloxacin is recommended for dog bite wounds at risk of infection, including those resulting in fractures 2.
• Antibiotic therapy is indicated for infected bite wounds and wounds at risk of infection, especially when involving important structures such as bones, vessels, and joints 3.
• The choice of antibiotic may depend on the location and severity of the bite, as well as the patient's overall health and risk of infection.

Specific Considerations for Fractures

• In cases of mandibular fracture following a dog bite, thorough and systematic examination of the facial skeleton is crucial to exclude the presence of such injuries 4.
• For complex panfacial fractures resulting from dog bites, primary repair and antibiotic therapy are essential for satisfactory results 3.

General Treatment Protocols

• A treatment protocol that includes copious saline pressure irrigation, meticulous wound and wound edge debridement, repeated copious saline pressure irrigation, adequate antibiotic treatment, and close postoperative monitoring can be effective in reducing the risk of infection 5.
• Immediate antibiotic therapy should be carefully evaluated for each patient, especially in cases of dog bite injuries to the hands, which are at increased risk of secondary presentations and infectious complications 6.