What topical antibiotics, such as Neosporin (neomycin/polymyxin B), are recommended for dog bites?

Topical Antibiotics for Dog Bites

Topical antibiotics such as Neosporin (neomycin/polymyxin B) are NOT recommended as primary treatment for dog bites. Instead, thorough wound cleansing followed by systemic antibiotics is the standard of care for dog bite wounds requiring antimicrobial therapy.

Initial Management of Dog Bites

1. Immediate Wound Cleansing:

   • Thoroughly irrigate the wound with soap and water for at least 15 minutes 1
   • Use warm or room temperature potable water in large volumes to remove foreign matter 1
   • Remove superficial debris but avoid deeper debridement unless necessary 1

2. Antibiotic Prophylaxis:

   • Systemic antibiotics (not topical) are indicated for:
     • Hand or facial bites
     • Deep puncture wounds
     • Immunocompromised patients
     • Wounds with significant tissue damage 1
   • First-line antibiotic: Amoxicillin-clavulanate (875/125 mg twice daily for 3-5 days) 1
   • For penicillin-allergic patients: Doxycycline (100 mg twice daily), fluoroquinolone plus metronidazole, or clindamycin plus TMP-SMZ 1
   • Children under 8 years should not receive doxycycline due to potential dental staining 1

Why Topical Antibiotics Are Not Recommended

Topical antibiotics like neomycin have several limitations for dog bite wounds:

1. Limited effectiveness: Dog bites often create deep puncture wounds where topical agents cannot penetrate effectively
2. Risk of absorption: Neomycin can be absorbed from body surfaces, potentially causing systemic effects including ototoxicity and nephrotoxicity 2
3. Allergic reactions: Cross-allergenicity among aminoglycosides has been demonstrated 2
4. Inappropriate coverage: Dog bite wounds typically contain polymicrobial bacteria including Pasteurella multocida 3, which requires systemic antibiotics for adequate treatment

Wound Closure Considerations

• Facial wounds may be closed primarily after thorough cleaning and with prophylactic antibiotics 1
• Other wounds may be considered for closure with Steri-Strips or left open 1
• Avoid suturing wounds >8 hours old (except facial wounds) 1
• Do not close infected wounds 1

Risk Factors for Infection

• Hand wounds have significantly higher infection rates and require special attention 4
• Puncture wounds are at higher risk for infection 5
• Delayed presentation (>8 hours) increases infection risk 5

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 1
• Elevate the affected area if there is inflammation to accelerate healing 1

Additional Considerations

• Evaluate tetanus vaccination status and administer tetanus toxoid if vaccination is outdated (>5 years) or unknown 1
• Consider rabies post-exposure prophylaxis based on circumstances of the bite and local rabies epidemiology 1

Meta-analyses have shown that prophylactic systemic antibiotics reduce infection rates in dog bites, with approximately 14 patients needing treatment to prevent one infection 6. The evidence for antibiotic prophylaxis is strongest for hand wounds, where the number needed to treat is only 4 7.