What is the proper treatment for a dog bite?

Management of Dog Bite Wounds

The proper treatment for a dog bite includes thorough wound cleansing with sterile normal saline, tetanus prophylaxis if needed, and amoxicillin-clavulanate for 3-5 days as first-line antibiotic prophylaxis, especially for high-risk wounds. 1

Initial Wound Management

1. Wound Cleansing:

   • Thoroughly irrigate the wound with copious amounts of sterile normal saline for about 15 minutes 2, 1
   • Avoid iodine or antibiotic-containing solutions 2
   • Remove superficial debris but avoid deep debridement that could enlarge the wound 2

2. Wound Assessment:

   • Evaluate for:
     • Depth of puncture
     • Proximity to bones/joints (pain disproportionate to injury near bone suggests periosteal penetration) 2
     • Hand wounds (often more serious than wounds to fleshy parts) 2
     • Neurovascular function (pulses, sensation) 3
     • Range of motion of adjacent joints 3

Antibiotic Prophylaxis

First-line antibiotic: Amoxicillin-clavulanate (875/125 mg twice daily for adults) for 3-5 days 1

Alternative options for penicillin-allergic patients:

• Doxycycline (100 mg twice daily)
• Fluoroquinolone plus metronidazole
• Clindamycin plus TMP-SMZ 1

Indications for antibiotic prophylaxis:

• Deep puncture wounds
• Hand or face injuries
• Immunocompromised patients
• Asplenic patients
• Advanced liver disease
• Wounds with resultant edema 1

Avoid using:

• First-generation cephalosporins
• Penicillinase-resistant penicillins
• Macrolides
• Clindamycin alone 1

The meta-analysis of randomized trials shows that prophylactic antibiotics reduce infection incidence in dog bite wounds (relative risk 0.56), with about 14 patients needing treatment to prevent one infection 4.

Wound Closure Considerations

• Infected wounds should not be closed 2
• Facial wounds may be closed primarily if there has been meticulous wound care, copious irrigation, and prophylactic antibiotics 2
• For other wounds, consider:
  • Approximation with Steri-Strips
  • Delayed primary closure
  • Secondary intention healing 2
• Primary closure may be performed if there is low risk of infection 3

Tetanus Prophylaxis

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• Administer tetanus toxoid (0.5 mL intramuscularly) if status is outdated or unknown 2, 1

Rabies Considerations

Evaluate need for rabies post-exposure prophylaxis based on:

• Animal type (domestic vs. wild)
• Animal's behavior and vaccination status
• Circumstances of bite (provoked vs. unprovoked)
• Geographic rabies prevalence 5

For domestic dogs that are healthy and available for 10-day observation, post-exposure prophylaxis is not needed unless the animal develops clinical signs of rabies 5.

Patient Monitoring and Follow-up

• Elevate the affected area if inflammation is present 1
• Follow up within 24 hours either by phone or office visit 2
• Monitor for signs of infection for at least 48 hours 1
• Consider hospitalization if infection progresses despite appropriate therapy 2

Potential Complications to Watch For

• Osteomyelitis (4-6 week treatment course)
• Synovitis (3-4 week treatment course)
• Nerve or tendon injury
• Compartment syndromes
• Post-infectious arthritis
• Fracture
• Bleeding 2

Dog bites represent a significant healthcare burden, accounting for approximately 337,000 emergency visits annually in the United States with medical costs up to $2 billion per year 3. Prompt and appropriate management is essential to prevent complications and ensure optimal outcomes.