What is the management plan for a dog bite?

Management of Dog Bites

The management of dog bites requires immediate wound irrigation, tetanus prophylaxis, assessment for rabies risk, and antibiotic prophylaxis with amoxicillin-clavulanate for high-risk wounds. 1

Initial Wound Management

• Immediate wound cleansing: Thoroughly wash and flush all bite wounds for approximately 15 minutes with soap or cleansing agent and copious amounts of water 2
• Apply an iodine-containing or similarly viricidal topical preparation to the wound when available 2
• Perform gentle irrigation with water or dilute povidone-iodine solution to decrease bacterial infection risk 1
• Use a 20-mL or larger syringe or a 20-gauge catheter for effective pressure irrigation 3

Wound Assessment and Exploration

• Explore the wound for:
  • Tendon or bone involvement
  • Possible foreign bodies
  • Deep structure involvement
  • Evidence of necrotic tissue 1, 3
• Pay special attention to hand wounds due to their higher risk of infection and treatment failure 1, 4
• Consider surgical management if:
  • An abscess has formed
  • Deep structures are involved
  • Necrotic tissue is present
  • Foreign body is suspected 1

Wound Closure Considerations

• Generally avoid suturing dog bite wounds when possible as it may increase infection risk 1
• Exceptions for wound closure:
  • Facial wounds (may be closed primarily with prophylactic antibiotics)
  • Wounds seen within 8 hours (consider approximation with Steri-Strips)
  • Cosmetically important areas 1, 3
• Consider delayed primary closure for wounds >8 hours old 1

Antibiotic Prophylaxis

• First-line antibiotic: Amoxicillin-clavulanate 875/125 mg twice daily 1

• Provides excellent coverage against common pathogens including:

  • Pasteurella multocida
  • Staphylococci
  • Streptococci
  • Anaerobic bacteria 1

• Alternative options for penicillin-allergic patients:

  • Fluoroquinolones (ciprofloxacin or levofloxacin) plus metronidazole
  • Second/third-generation cephalosporins with anaerobic coverage
  • Doxycycline (avoid during pregnancy) 1

• Prophylactic antibiotics are specifically recommended for:

  • All dog bites to the hand
  • Deep puncture wounds
  • Wounds requiring surgical debridement
  • Immunocompromised patients
  • Wounds involving joints, tendons, or bones 1

• Standard treatment duration: 5-7 days (may be extended if no improvement) 1

Tetanus Prophylaxis

• Administer tetanus toxoid (0.5 mL intramuscularly) if vaccination status is outdated or unknown 1, 2

Rabies Risk Assessment and Prophylaxis

• Assess rabies risk based on:

  1. Animal type and status: Healthy domestic dogs should be confined and observed for 10 days; no prophylaxis needed unless animal develops clinical signs of rabies 2
  2. Circumstances of bite: Unprovoked attacks may indicate higher rabies risk 2
  3. Type of exposure: Bite (penetration of skin by teeth) or nonbite (scratches, abrasions, open wounds contaminated with saliva) 2

• If the dog is:

  • Healthy and available for 10-day observation: No immediate prophylaxis needed unless animal develops signs of rabies
  • Rabid or suspected rabid: Immediate prophylaxis
  • Unknown/escaped: Consult public health officials 2

• When indicated, rabies post-exposure prophylaxis consists of:

  • Rabies immune globulin at presentation
  • Vaccination on days 0,3,7, and 14 2, 3

Special Considerations

• Hand bites require special attention due to higher infection risk and potential for treatment failure 1, 4
• High-risk patients (immunocompromised, elderly, cirrhosis, asplenia) require broader spectrum antibiotics, closer monitoring, and possible hospitalization 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

Follow-up

• Assess response to treatment within 24-48 hours
• Monitor for signs of worsening infection
• Look for increasing pain, erythema, swelling, or purulent drainage 1
• Consider extending treatment if no improvement after 5 days 1

Reporting Requirements

• In most states, physicians are required by law to report animal bites to appropriate authorities 3