What is the treatment for a dog bite in cases of re-exposure?

Treatment for Dog Bite Re-Exposure

For previously vaccinated individuals with a new dog bite, immediate wound cleansing plus two doses of rabies vaccine on days 0 and 3 is the recommended treatment, without rabies immune globulin administration. 1

Initial Wound Management

• Immediately and thoroughly wash all bite wounds with soap and water for at least 30 seconds 2
• Consider using a virucidal agent such as povidone-iodine solution for additional cleansing 1, 2
• Irrigate thoroughly to remove all foreign matter 2
• Evaluate the wound for depth, location, and potentially involved structures 2
• Avoid suturing when possible to reduce infection risk 1
• Apply antibiotic ointment and cover with a clean occlusive dressing 2

Rabies Prophylaxis for Previously Vaccinated Individuals

For persons who have previously received complete rabies vaccination:

• Administer 2 doses of rabies vaccine (1.0 mL IM each)
  • First dose: As soon as possible after exposure (day 0)
  • Second dose: 3 days later (day 3) 1
• Do NOT administer Human Rabies Immune Globulin (HRIG) 1

Infection Prevention

• Ensure tetanus prophylaxis is current 2, 3
• Consider antibiotic prophylaxis, especially for high-risk bites 2, 3
  • Amoxicillin-clavulanate is the first-line choice 3, 4
  • Alternative options include doxycycline or trimethoprim-sulfamethoxazole plus clindamycin for penicillin-allergic patients

Special Considerations

• Hand bites carry the highest risk of infection and require careful evaluation 2
• Monitor for signs of infection for at least 48 hours after the bite 2
• Consider the circumstances of the bite:
  • Unprovoked attacks are more likely to indicate rabid animals 1
  • Bites from unknown or stray dogs carry higher risk 5
  • Geographic location matters - bites in rabies-endemic areas require more aggressive management 1, 6

Common Pitfalls to Avoid

1. Delaying wound cleansing - immediate thorough washing significantly reduces infection and rabies risk 1, 2
2. Administering HRIG to previously vaccinated individuals - unnecessary and may suppress antibody response 1
3. Closing large bite wounds without proper cleaning - increases infection risk 2
4. Using the gluteal area for vaccine injection - results in lower neutralizing antibody titers 1
5. Failing to identify the biting animal when possible - observation of the animal can guide treatment decisions 1

The management approach differs significantly between previously vaccinated and unvaccinated individuals. For unvaccinated persons, a full course of 5 vaccine doses plus HRIG would be required, whereas previously vaccinated individuals need only the abbreviated 2-dose regimen without HRIG 1.