What are the discharge instructions for a patient with a dog bite being prescribed Augmentin (amoxicillin/clavulanate)?

Dog Bite Discharge Instructions with Augmentin

Amoxicillin-clavulanate (Augmentin) 875/125 mg twice daily for 3-5 days is the preferred antibiotic treatment for dog bite wounds due to its excellent coverage against Pasteurella species and anaerobes. 1

Wound Care Instructions

1. Immediate wound cleaning:

   • Thoroughly wash the wound with soap and water
   • Apply a virucidal agent such as povidone-iodine solution
   • Irrigate copiously with sterile saline or water to remove bacteria and debris

2. Wound management:

   • Small, clean wounds less than 8 hours old may be considered for primary closure
   • Puncture wounds or contaminated wounds should be left open to heal by secondary intention
   • Apply a clean, dry dressing and change it daily or when soiled

Medication Instructions

1. Augmentin (amoxicillin-clavulanate) administration:

   • Take 875/125 mg twice daily with meals or snacks to reduce gastrointestinal upset 1, 2
   • Complete the entire course of antibiotics even if you feel better before finishing 2
   • Take at evenly spaced intervals (approximately every 12 hours)

2. Important medication warnings:

   • Take with food to minimize stomach upset 2
   • Be aware that Augmentin contains a penicillin-class drug that can cause allergic reactions 2
   • If severe diarrhea develops, especially if bloody, contact your physician immediately 2

Follow-Up Instructions

1. Return for follow-up within 24-48 hours to monitor for signs of infection 1

2. Seek immediate medical attention if you develop:

   • Increasing redness, warmth, swelling around the wound
   • Increasing pain or tenderness
   • Purulent (pus-like) discharge
   • Fever, chills, or other systemic symptoms
   • Red streaking from the wound
   • Significant swelling or loss of function

Tetanus Prophylaxis

• Tetanus toxoid should be administered if vaccination is not current (within last 5 years for dirty wounds, 10 years for clean wounds) 1
• Tdap is preferred over Td if not previously given 1

Special Considerations

1. High-risk patients requiring closer monitoring include:

   • Elderly with multiple comorbidities
   • Immunocompromised individuals
   • Asplenic patients
   • Patients with cirrhosis 1

2. Hand bites require special attention due to higher risk of complications and may need surgical consultation 1

Rabies Prevention

• A healthy domestic dog that bites should be confined and observed for 10 days to assess the risk of rabies transmission 1
• If the dog's rabies vaccination status is unknown or the dog cannot be observed, consult with local health department regarding rabies prophylaxis

Common Pitfalls to Avoid

1. Do not use first-generation cephalosporins, penicillinase-resistant penicillins, macrolides, or clindamycin alone as they have poor activity against Pasteurella multocida commonly found in dog bites 1

2. Do not skip doses or stop antibiotics early even if symptoms improve, as this may decrease effectiveness and increase antibiotic resistance 2

3. Do not ignore signs of infection in high-risk patients (elderly, immunocompromised, asplenic, cirrhotic) as infections can progress rapidly 1

4. Do not close heavily contaminated wounds or puncture wounds as this may increase infection risk 1

Augmentin is the optimal choice for dog bite prophylaxis due to its broad spectrum coverage against the polymicrobial nature of dog bite wounds, which typically yield 5 different bacterial isolates including Pasteurella species and anaerobes 1.