What is the treatment for a dog bite?

Treatment of Dog Bite Wounds

Immediate and thorough washing of all bite wounds and scratches with soap and water is the most important initial measure for preventing rabies and bacterial infections in dog bite wounds. 1

Initial Wound Management

1. Local Wound Care:

   • Copious irrigation with sterile saline or water to remove bacteria and debris
   • Thorough cleansing with soap and water has been shown to markedly reduce the likelihood of rabies 1
   • Removal of superficial debris (deeper debridement usually unnecessary) 2
   • Assess for damage to underlying structures (tendons, nerves, blood vessels, bone)

2. Wound Closure Decisions:

   • Facial wounds: May be closed primarily after meticulous wound care and with prophylactic antibiotics 2
   • Non-facial wounds: Generally should not be closed primarily; use Steri-Strips and consider delayed primary or secondary closure 2
   • Infected wounds: Never close 2
   • Puncture wounds or contaminated wounds: Leave open to heal by secondary intention 2
   • Small, clean wounds <8 hours old: May consider primary closure 2

Antibiotic Therapy

1. Indications for Prophylactic Antibiotics:

   • Moderate to severe wounds
   • Puncture wounds, especially on hands
   • Wounds with crush injury
   • Wounds in immunocompromised patients
   • Wounds involving joints, tendons, ligaments, or fractures

2. First-line Oral Antibiotic Therapy:

   • Amoxicillin-clavulanate (875/125 mg twice daily for 3-5 days) 1, 2
   • Dog bite wounds typically contain a polymicrobial mixture of aerobic and anaerobic bacteria 2

3. Alternative Oral Options (for penicillin allergies):

   • Doxycycline (100 mg twice daily) - excellent activity against Pasteurella multocida 2
   • Fluoroquinolone (e.g., levofloxacin) plus metronidazole or clindamycin 2
   • Clindamycin plus trimethoprim-sulfamethoxazole 2

4. Intravenous Therapy (for severe infections):

   • Ampicillin-sulbactam (1.5-3g IV every 6-8 hours) 2
   • Alternative: piperacillin-tazobactam, second-generation cephalosporins, or carbapenems 2

5. Treatment Duration:

   • Standard course: 7-14 days 2
   • Extended treatment (3-4 weeks) for osteomyelitis, septic arthritis, or slow-resolving infections 2

Tetanus Prophylaxis

• Administer tetanus toxoid if vaccination is not current:

  • 5 years since last dose for dirty wounds

  • 10 years for clean wounds

• Tdap preferred over Td if not previously given 2

Rabies Assessment and Prophylaxis

1. Animal Assessment:

   • A healthy domestic dog that bites should be confined and observed for 10 days 1
   • Any illness in the animal during confinement should be evaluated by a veterinarian and reported to local health department 1
   • Stray or unwanted dogs that bite may be euthanized immediately and tested for rabies 1

2. Rabies Prophylaxis Considerations:

   • Consult local health department about risks and benefits 2
   • Consider vaccination status of dog, availability for observation, and local rabies epidemiology
   • If indicated, begin treatment within 24 hours with both human rabies immune globulin (HRIG) and rabies vaccine 1

Special Considerations

1. Hand Injuries:

   • Higher risk of infection and complications 3
   • Consider surgical consultation for deep infections or if tendons/bones involved 2
   • More aggressive management and closer follow-up needed

2. High-Risk Patients:

   • Asplenic patients: Higher risk for overwhelming Capnocytophaga canimorsus sepsis 2
   • Cirrhotic patients: Increased risk of severe infection and sepsis 2
   • Immunocompromised: Lower threshold for IV antibiotics and hospitalization

Follow-up and Monitoring

• Follow-up within 24-48 hours to assess for signs of infection 2
• Monitor for:
  • Increasing pain, swelling, redness
  • Purulent discharge
  • Fever or systemic symptoms
• Consider inflammatory markers (CRP, ESR) if clinical assessment is equivocal 2
• If infection progresses despite appropriate antibiotics, consider hospitalization 2

Indications for Hospitalization

• Severe infections
• Moderate infections with relevant comorbidities
• Extensive infection or slow resolution
• Systemic symptoms
• Need for IV antibiotics or surgical intervention

The management of dog bites requires prompt attention to wound care, appropriate antibiotic selection, and consideration of tetanus and rabies prophylaxis to prevent serious complications and ensure optimal outcomes.