What are the discharge instructions for a patient after a dog bite?

From the Guidelines

After a dog bite, it is crucial to clean the wound thoroughly with soap and water for at least 5 minutes, then apply an antibiotic ointment like Neosporin and cover with a clean bandage to prevent infection and promote healing. The risk of infection from dog bites is significant due to the bacteria present in a dog's mouth, making prompt and proper wound care essential 1.

Key Steps for Wound Care and Management

• Clean the wound with soap and water for at least 5 minutes.
• Apply an antibiotic ointment and cover with a clean bandage.
• Change the dressing daily and monitor for signs of infection, including increasing redness, swelling, warmth, pus, or red streaks extending from the wound.
• Take prescribed antibiotics completely as directed, typically amoxicillin-clavulanate (Augmentin) 875/125 mg twice daily for 5-7 days for adults, as recommended for preventing infection in bite wounds 1.
• For pain management, take acetaminophen (Tylenol) 650 mg every 6 hours or ibuprofen (Advil) 400-600 mg every 6 hours as needed.
• Elevate the affected area to reduce swelling and apply ice for 15-20 minutes several times daily.

Follow-Up and Prevention of Further Complications

• Seek immediate medical attention if you develop fever, severe pain, significant swelling, or if the wound appears infected.
• Return for follow-up as scheduled, typically in 2-3 days.
• Verify your tetanus vaccination status - if it's been more than 5 years since your last shot, you may need a booster, as tetanus prophylaxis is an important aspect of wound management 1.
• Consideration should also be given to rabies prophylaxis, especially for bites from feral or wild animals, or in areas with a high prevalence of rabies, following guidelines such as those outlined by the Advisory Committee on Immunization Practices 1.

Given the potential for serious complications, including infection, nerve or tendon damage, and the risk of rabies, it is essential to approach dog bite wounds with a thorough and cautious management plan, prioritizing wound care, antibiotic prophylaxis when necessary, and follow-up to prevent morbidity and mortality.

From the Research

Discharge Instructions for Dog Bite Patients

The following instructions are based on studies of dog bite wounds and infections 2, 3, 4, 5, 6.

• Wound Care:
  • Clean the wound with soap and water
  • Apply antibiotic ointment to the wound
  • Cover the wound with a bandage
• Antibiotic Therapy:
  • Prophylactic antibiotics may be indicated for high-risk wounds, such as those on the hands, face, or genital area, or for patients who are immunocompromised or asplenic 4
  • Amoxicillin-clavulanate is a common first-line choice of antibiotic 4
  • However, studies have shown that prophylactic penicillin may not prevent infection in dog bite wounds 5
• Follow-up Care:
  • Patients should be seen in follow-up in 3-4 days and again at 7-10 days or earlier if signs of inflammation occur 5
  • Patients with injuries to the hand are at increased risk of secondary presentations and should be closely monitored 6
• Tetanus and Rabies Prophylaxis:
  • Appropriate tetanus and rabies prophylaxis should be administered as indicated 4
• Signs of Infection:
  • Patients should be instructed to watch for signs of infection, such as redness, swelling, increased pain, or pus, and to seek medical attention immediately if these symptoms occur 6

Special Considerations

• Hand Injuries:
  • Bites to the hands are at high risk of infection and should be carefully evaluated for antibiotic therapy 6
• Immunocompromised Patients:
  • Patients who are immunocompromised or asplenic may require prophylactic antibiotics and close monitoring for signs of infection 4