What is the recommended treatment for a dog bite?

Management of Dog Bite Wounds

The proper treatment for a dog bite requires immediate thorough wound cleansing with soap and water, followed by antibiotic therapy with amoxicillin-clavulanate for 3-5 days, especially for moderate to severe injuries or in high-risk patients. 1

Initial Wound Care

• Immediately clean the wound thoroughly with copious amounts of warm water and soap to remove foreign matter and reduce bacterial burden 1, 2
• Avoid high-pressure irrigation as it may spread bacteria into deeper tissue layers 1
• Debride any necrotic tissue 1
• Elevate the affected area if there is inflammation to accelerate healing 3, 1

Assessment of the Wound

• Examine for:
  • Depth of wound (puncture vs. crush injury)
  • Involvement of tendons, bones, or joint capsules
  • Presence of foreign bodies
  • Signs of infection (redness, swelling, warmth, pain)
• Document the wound with photographs when appropriate 4

Antibiotic Therapy

• Prophylactic antibiotics are recommended for:

  • Moderate to severe bite wounds
  • Puncture wounds
  • Hand, face, or foot wounds
  • Wounds that have undergone primary closure
  • Immunocompromised patients
  • Wounds with signs of infection 1, 5

• First-line antibiotic: Amoxicillin-clavulanate

  • Adults: 875/125 mg twice daily for 3-5 days
  • Children: Dosing based on weight 1

• For penicillin-allergic patients:

  • Doxycycline (if >8 years old)
  • Fluoroquinolone plus metronidazole (if >18 years old)
  • Clindamycin plus trimethoprim-sulfamethoxazole 1

• Avoid first-generation cephalosporins, penicillinase-resistant penicillins, macrolides, and clindamycin alone as they have poor activity against Pasteurella multocida 3, 1

Wound Closure Considerations

• Primary closure may be considered for:

  • Facial wounds (for cosmetic reasons)
  • Gaping wounds that require approximation 1, 6

• If closing the wound:

  • Ensure thorough irrigation and debridement first
  • Consider loose closure with minimal sutures
  • Provide mandatory antibiotic coverage 1

• Generally avoid suturing puncture wounds or infected wounds 1, 2

Rabies Post-Exposure Prophylaxis Assessment

• Evaluate the circumstances of the bite (provoked vs. unprovoked) 1, 2

• Check the animal's vaccination status and availability for observation 1, 2

• For domestic dogs:

  • If healthy and available: Observe for 10 days, no prophylaxis needed unless animal develops rabies 2
  • If rabid or suspected rabid: Administer rabies immune globulin and vaccine 2
  • If unknown/escaped: Consult public health officials 2

• If rabies prophylaxis is indicated:

  • Human rabies immune globulin (HRIG): 20 IU/kg body weight
  • Five-dose regimen of rabies vaccine on days 0,3,7,14, and 28 1, 2

Tetanus Prophylaxis

• Evaluate tetanus vaccination status
• Administer tetanus toxoid if not up-to-date or unknown 1

Follow-Up and Monitoring

• Follow-up within 24-48 hours to assess for infection

• Monitor for signs of infection for at least 48 hours:

  • Increasing redness, swelling, pain, warmth
  • Purulent drainage
  • Fever 1

• Instruct patients to return immediately if signs of infection appear 1

Common Pitfalls to Avoid

• Delaying wound cleansing and antibiotic treatment when indicated
• Using inappropriate antibiotics with poor coverage against common pathogens
• Relying solely on the owner's report of the animal's vaccination status for rabies management
• Failing to consider tetanus prophylaxis
• Inappropriate primary closure of high-risk wounds 3, 1

Meta-analysis evidence shows that prophylactic antibiotics reduce the incidence of infection in dog bite wounds, with a relative risk of 0.56 (95% confidence interval, 0.38 to 0.82) compared to no antibiotics 7.