From the Guidelines
Management of dog bites requires immediate cleaning of the wound with soap and water for at least 5 minutes, followed by irrigation with normal saline or clean water under pressure, and antibiotic prophylaxis with amoxicillin-clavulanate (Augmentin) 875/125 mg twice daily for 3-5 days for high-risk wounds, as recommended by the most recent guidelines 1. The optimal medical treatment of animal bite wounds includes the recognition and treatment of serious injury, avoidance or management of infection, and approaches that will yield the best possible cosmetic results 1. Some key points to consider in the management of dog bites include:
- Immediate cleaning and irrigation of the wound to reduce the risk of infection
- Application of an antiseptic solution like povidone-iodine or chlorhexidine to the wound
- Use of antibiotic ointment and coverage with a sterile bandage for minor wounds
- Seeking medical attention for deep wounds, facial injuries, or if the bite is from an unknown or unvaccinated dog
- Consideration of tetanus prophylaxis if the patient's vaccination status is incomplete or unknown
- Potential need for rabies post-exposure prophylaxis, including rabies immune globulin and a series of rabies vaccines, depending on the circumstances of the bite and the dog's vaccination status The bacteria in canine oral flora, particularly Pasteurella, Streptococcus, Staphylococcus, and anaerobes, pose a high risk of infection, making prompt cleaning and appropriate antibiotic coverage essential 1. It is also important to note that the management of dog bites may vary depending on the individual circumstances of the bite, and healthcare providers should use their clinical judgment to determine the best course of treatment. In terms of specific antibiotic regimens, the guidelines recommend amoxicillin-clavulanate (Augmentin) 875/125 mg twice daily for 3-5 days for high-risk wounds 1. Overall, the management of dog bites requires a comprehensive approach that takes into account the risk of infection, the need for prompt cleaning and antibiotic coverage, and the potential need for tetanus and rabies prophylaxis.
From the Research
Management of Canine (Dog) Bites
The management of canine (dog) bites involves several key steps to prevent infection and promote healing.
- Cleaning and irrigation of the wound: The wound should be cleaned and copiously irrigated with normal saline using a 20-mL or larger syringe or a 20-gauge catheter attached to the syringe 2, 3.
- Exploration of the wound: The wound should be explored for tendon or bone involvement and possible foreign bodies 2.
- Wound closure: Wounds may be closed if cosmetically favorable, such as wounds on the face or gaping wounds 2.
- Antibiotic prophylaxis: Antibiotic prophylaxis should be considered, especially if there is a high risk of infection, such as with cat bites, with puncture wounds, with wounds to the hand, and in persons who are immunosuppressed 2, 4, 3.
- Rabies prophylaxis: The need for rabies prophylaxis should be addressed with any animal bite because even domestic animals are often unvaccinated 2, 5.
- Documentation: The dog bite injury should be documented with photographs and diagrams when appropriate 4.
- Education: Family physicians should educate parents and children on ways to prevent dog bites 4, 3.
Antibiotic Prophylaxis
The use of antibiotic prophylaxis in dog bite management is recommended in certain situations, such as:
- High-risk wounds: Wounds with a high risk of infection, such as puncture wounds or wounds to the hand 2, 3.
- Immunocompromised individuals: Individuals who are immunosuppressed may require antibiotic prophylaxis 2.
- First-line prophylactic antibiotic: Amoxicillin/clavulanate is the first-line prophylactic antibiotic 2.
Rabies Prophylaxis
Rabies prophylaxis is indicated in certain situations, such as: