What is the treatment for a dog scratch?

Treatment for Dog Scratches

For dog scratches, immediate and thorough washing of the wound with soap and water for 15 minutes is the most important first-line treatment, followed by application of a topical antiseptic like povidone-iodine and consideration of oral antibiotics for high-risk wounds. 1

Immediate Wound Care

1. Clean the wound thoroughly:

   • Wash with copious amounts of water or saline for about 15 minutes 1
   • Use soap and water to mechanically remove bacteria and debris
   • Apply a virucidal agent such as povidone-iodine solution for irrigation 2
   • This thorough cleansing alone can markedly reduce the likelihood of infection 2

2. Wound assessment:

   • Evaluate depth and severity of the scratch
   • Check for signs of infection (redness, swelling, warmth, pain)
   • Determine time elapsed since injury

Antibiotic Therapy

When to use antibiotics:

Antibiotic prophylaxis should be considered for:

• Deep scratches that penetrate the dermis
• Scratches on hands, face, or over joints
• Immunocompromised patients
• Scratches with signs of early infection
• Wounds with resultant edema 1

Recommended antibiotics:

• First-line: Amoxicillin-clavulanate 875/125 mg twice daily for 3-5 days 1
• For penicillin-allergic patients: Doxycycline, fluoroquinolone plus metronidazole, or clindamycin plus TMP-SMZ 1

Dog scratches can be contaminated with multiple bacteria including:

• Pasteurella species (most common)
• Staphylococcus aureus
• Bacteroides species
• Fusobacterium species
• Capnocytophaga species
• Porphyromonas species 2

Topical Treatment

For minor scratches without signs of infection:

• After cleaning, apply a small amount of topical antibiotic (like bacitracin) 1-3 times daily 3
• May be covered with a sterile bandage
• For children under 2 years, consult a doctor before using topical antibiotics 3

Additional Considerations

Tetanus Prophylaxis

• Evaluate tetanus vaccination status
• Administer tetanus toxoid if status is outdated (>5 years) or unknown 1

Rabies Risk Assessment

• While rabies is rare from scratches alone (more common with bites), assess the circumstances:
  • Was the attack unprovoked? (Higher risk)
  • Is the dog's vaccination status known?
  • Is the dog available for observation? 2
• If rabies is a concern, consult local health officials regarding post-exposure prophylaxis 1

Follow-up Care

• Schedule follow-up within 24-48 hours to assess for signs of infection 1
• Monitor for increasing redness, swelling, pain, warmth, or drainage
• Elevate the affected area if there is inflammation 1

Special Considerations

• Severe infections: In rare cases, dog scratches can lead to severe infections, including necrotizing streptococcal infections 4 or unusual pathogens like Serratia marcescens in immunocompromised patients 5
• High-risk patients: Immunocompromised individuals, those with asplenia, or advanced liver disease should receive more aggressive prophylactic treatment 1

Warning Signs Requiring Immediate Medical Attention

• Rapidly spreading redness or swelling
• Fever or chills
• Increasing pain
• Pus or foul-smelling discharge
• Red streaks extending from the wound

Remember that while dog bites receive more attention in medical literature, scratches can also transmit pathogenic bacteria and should be treated promptly and appropriately to prevent infection.