What is the proper treatment for a dog bite?

Proper Treatment for Dog Bites

The proper treatment for a dog bite includes thorough wound cleansing with sterile normal saline, removal of superficial debris, and administration of amoxicillin-clavulanate as the first-line antibiotic prophylaxis for all bites, particularly those at high risk of infection. 1, 2

Initial Wound Management

• Immediately clean the wound with sterile normal saline (not iodine or antibiotic-containing solutions)
• Remove superficial debris but avoid deep debridement that could enlarge the wound 3
• Do not close infected wounds; for non-infected wounds:
  • Facial wounds may be closed primarily with prophylactic antibiotics 3
  • For other wounds seen within 8 hours, consider approximation with Steri-Strips rather than sutures 3
  • Wounds seen after 8-12 hours typically have established infection and should not be closed 3

Antibiotic Therapy

• First-line treatment: Amoxicillin-clavulanate 875/125 mg twice daily 1, 4, 2
• For penicillin-allergic patients: Alternative options include:
  • Doxycycline (excellent alternative) 1
  • Clindamycin plus fluoroquinolone 1
  • Metronidazole plus fluoroquinolone 1
  • Trimethoprim-sulfamethoxazole plus metronidazole 1
• Avoid: First-generation cephalosporins, penicillinase-resistant penicillins, macrolides, and clindamycin alone (poor activity against Pasteurella multocida) 1

Treatment Duration

• 7-10 days for localized infections
• 10-14 days for severe or systemic infections
• 3-4 weeks for complicated infections (osteomyelitis, septic arthritis) 1, 3

High-Risk Wounds Requiring Antibiotic Prophylaxis

• Puncture wounds (especially if penetrating bone, tendon, or joint)
• Hand or foot wounds (higher risk of complications)
• Facial wounds
• Moderate to severe wounds
• Wounds in immunocompromised patients
• Wounds that have undergone primary closure 1, 5

Special Considerations

1. Tetanus prophylaxis:

   • Administer tetanus toxoid (0.5 mL intramuscularly) if vaccination status is outdated or unknown 3, 1

2. Rabies prophylaxis:

   • Consider for all feral and wild animal bites
   • Consult local department of health regarding risks and benefits
   • If indicated: rabies immunoglobulin on day 0, followed by rabies human diploid cell vaccination 3, 1

3. Follow-up care:

   • Outpatients should be followed up within 24 hours either by phone or office visit 3
   • Monitor for signs of worsening infection 1

Indications for Hospitalization

• Severe infections with systemic symptoms
• Deep infections involving tendons or joints
• Hand infections
• Immunocompromised patients with moderate to severe infections 1

Common Pitfalls to Avoid

1. Inadequate wound cleaning: Thorough irrigation is essential to prevent infection
2. Inappropriate antibiotic selection: Avoid antibiotics with poor activity against common bite pathogens
3. Premature wound closure: Infected wounds should not be closed
4. Delayed treatment: Dog bites should be treated promptly, as infection risk increases with time
5. Overlooking deep structure damage: Always assess for nerve, tendon, or bone involvement 3, 1, 2

Meta-analysis evidence shows that prophylactic antibiotics reduce the incidence of infection in dog bite wounds, with a relative risk of 0.56 (95% CI: 0.38-0.82) compared to controls 6. The estimated infection rate without antibiotics is approximately 16%, making antibiotic prophylaxis a reasonable approach for most dog bites, especially those at higher risk of infection.

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