What is the recommended treatment for a dog bite?

Dog Bite Treatment

The recommended treatment for dog bites includes immediate and thorough washing of all bite wounds with soap and water, followed by irrigation with povidone-iodine solution, prophylactic antibiotics (amoxicillin-clavulanate) for high-risk wounds, tetanus prophylaxis if needed, and assessment for rabies risk. 1

Initial Wound Management

1. Immediate Wound Cleaning:

   • Thoroughly wash all bite wounds with soap and water immediately 2, 1
   • Follow with irrigation using povidone-iodine solution 1
   • This simple measure markedly reduces the risk of both rabies and bacterial infection 1

2. Wound Assessment and Closure:

   • Avoid suturing puncture wounds when possible 1
   • Allow puncture wounds to heal by secondary intention 1
   • Primary closure may be considered for facial wounds only 1
   • Remove any visible foreign material 1
   • Evaluate for damage to underlying structures (tendons, joints, bones) 1

Antibiotic Prophylaxis

Indications for prophylactic antibiotics 1, 3:

• All bites to the hand
• Deep puncture wounds
• Wounds requiring surgical debridement
• Immunocompromised patients
• Wounds involving joints, tendons, or bones
• Moderate to severe injuries, especially to face
• Patients with risk factors (immunocompromised, asplenia, advanced liver disease)

Antibiotic regimen:

• First-line: Amoxicillin-clavulanate 875/125 mg twice daily for 3-5 days 1, 4
• Alternatives: Ampicillin-sulbactam or piperacillin-tazobactam 1

Tetanus Prophylaxis

• Administer tetanus prophylaxis if vaccination is not current within 10 years 1
• For patients with unknown or incomplete tetanus vaccination history, consider tetanus immune globulin plus tetanus toxoid 1
• Tdap is preferred over Td if not previously given 1

Rabies Risk Assessment and Prophylaxis

1. Risk Assessment Factors 2, 1, 5:

   • Geographic location (rabies endemic areas)
   • Vaccination status of the dog
   • Circumstances of bite (provoked vs. unprovoked)
   • Unprovoked attacks are more likely to indicate rabid animals

2. Rabies Post-Exposure Prophylaxis 2, 1, 5:

   • For high-risk exposures: Human rabies immune globulin (HRIG) 20 IU/kg body weight AND rabies vaccine series (5 doses on days 0,3,7,14, and 28)
   • For previously vaccinated individuals: Only vaccine (no HRIG)
   • Begin treatment within 24 hours of exposure when possible

Special Considerations

1. Follow-up Care:

   • Patients should be followed up within 24-48 hours 1
   • Monitor for signs of infection (increasing erythema, pain, swelling, purulent discharge, systemic symptoms) 1

2. High-Risk Patients:

   • Elderly, immunocompromised, cirrhosis, asplenia require closer monitoring 1
   • May benefit from more aggressive antibiotic therapy 1

3. Indications for Hospitalization 1:

   • Severe infections with systemic symptoms
   • Deep infections involving tendons or joints
   • Hand infections
   • Immunocompromised patients with moderate to severe infections

4. Surgical Consultation 1:

   • Required for deep infections, abscess formation, compartment syndrome, or necrotizing infections
   • Consider early surgical exploration for hand wounds due to higher risk of complications

Common Pitfalls to Avoid

• Delayed wound cleaning: Immediate cleaning is critical for preventing infection and rabies 2, 1, 6
• Inappropriate wound closure: Avoid suturing puncture wounds except on the face 1
• Overlooking rabies risk: Always assess rabies risk based on dog's vaccination status and circumstances of bite 2, 5
• Neglecting tetanus status: Always verify tetanus immunization status 1
• Inappropriate antibiotic selection: Amoxicillin-clavulanate is the first-line choice due to its broad coverage against aerobic and anaerobic bacteria 1, 4