Dog Bite Management
The recommended management for dog bites includes thorough wound cleansing with sterile normal saline, antibiotic prophylaxis with amoxicillin-clavulanate, assessment for tetanus and rabies prophylaxis, and appropriate wound closure decisions based on wound characteristics and timing. 1
Initial Wound Care
- Immediate gentle irrigation with water or dilute povidone-iodine solution to markedly decrease risk of bacterial infection 2
- Remove superficial debris and devitalized tissue 1
- Avoid damaging surrounding tissues during cleansing 2
- Elevate the affected area to reduce swelling 1
Wound Closure Considerations
- Facial wounds may be closed primarily with prophylactic antibiotics 1
- Wounds seen within 8 hours may be considered for approximation with Steri-Strips rather than sutures 1
- Wounds seen after 8-12 hours typically have established infection and should not be closed 1
- Consider delayed primary closure for wounds >8 hours old 1
- Suturing should generally be avoided when possible 2
Antibiotic Prophylaxis
- Amoxicillin-clavulanate 875/125 mg twice daily is the first-line antibiotic choice 1, 3
- Prophylactic antibiotics should be considered for:
- All dog bites to the hand
- Deep puncture wounds
- Wounds requiring surgical debridement
- Immunocompromised patients
- Wounds involving joints, tendons, or bones 1
- Alternative options for penicillin-allergic patients:
- Doxycycline
- Clindamycin plus a fluoroquinolone
- Metronidazole plus a fluoroquinolone or trimethoprim-sulfamethoxazole 1
- Treatment duration for uncomplicated infections: 5-7 days 1
Tetanus Prophylaxis
- Administer tetanus toxoid (0.5 mL intramuscularly) if vaccination status is outdated or unknown 1
- Evaluate need for tetanus immunoglobulin based on wound characteristics and vaccination history 3
Rabies Prophylaxis
- Consider rabies prophylaxis for all dog bites, especially from stray or wild animals 1
- Consult local department of health regarding rabies risk assessment 1
- If indicated, administer rabies immunoglobulin on day 0, followed by rabies human diploid cell vaccination 1
- A healthy dog that bites a person should be confined and observed for 10 days 2
- Any illness in the confined animal should be reported immediately to local health department 2
- Stray or unwanted dogs that bite may be humanely killed and tested for rabies 2
Special Considerations
- High-risk wounds requiring special attention:
- Bites to the hand or over joints
- Deep puncture wounds
- Wounds in immunocompromised patients
- Wounds with significant crush injury 1
Follow-up Care
- Assess for response to treatment within 24-48 hours 1
- Monitor for signs of worsening infection (increasing pain, erythema, swelling, or purulent drainage) 1
- Consider inflammatory markers and wound culture to guide antibiotic therapy if infection develops 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
- Avoiding first-generation cephalosporins, penicillinase-resistant penicillins, macrolides, or clindamycin alone due to poor activity against Pasteurella multocida 1
- Failing to consider rabies prophylaxis, especially for bites from unknown or stray dogs 2
- Closing infected wounds or wounds seen after 8-12 hours 1
- Inadequate wound irrigation and debridement, which are at least equally important as antibiotics for infection prevention 4
Dog bites require prompt attention to prevent infection and other complications. The management approach outlined above addresses the key aspects of care to optimize outcomes and reduce morbidity.