What is the treatment for a dog bite?

Treatment for Dog Bites

The treatment for a dog bite should include thorough wound cleansing with soap and water for at least 15 minutes, followed by antibiotic prophylaxis with amoxicillin-clavulanate (875/125 mg twice daily for 3-5 days), and assessment for tetanus and rabies prophylaxis. 1

Immediate Wound Management

1. Wound Cleansing:

   • Immediately wash and flush all bite wounds with soap and water for at least 15 minutes 1
   • Use povidone-iodine solution for irrigation as a virucidal agent 1
   • Irrigate with a large volume of warm or room temperature potable water to remove foreign matter 1
   • Remove any superficial debris but avoid deeper debridement unless absolutely necessary 1

2. Wound Assessment:

   • Examine for neurovascular function (pulses, sensation) and range of movement of adjacent joints 2
   • Assess depth of wound - dog bites typically cause crush and soft-tissue avulsion injuries 2
   • Pay special attention to bites over joints, tendons, or on hands which have higher risk of complications 1

3. Wound Closure:

   • Facial wounds may be closed primarily after thorough cleaning and with prophylactic antibiotics 1
   • For non-facial wounds, consider using Steri-Strips or leaving open 1
   • Avoid suturing wounds >8 hours old (except facial wounds) 1
   • Primary surgical repair is appropriate for most clinically uninfected facial bite wounds 3

Antibiotic Prophylaxis

Antibiotic prophylaxis is indicated for:

• Bites to the hand or face
• Deep puncture wounds
• Immunocompromised patients
• Wounds with significant tissue damage 1

First-line antibiotic regimen:

• Amoxicillin-clavulanate 875/125 mg twice daily for 3-5 days 1, 4
• This combination provides coverage against common pathogens including Pasteurella multocida, Staphylococcus aureus, and oral anaerobes 3

For penicillin-allergic patients, alternatives include:

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

Tetanus and Rabies Prophylaxis

1. Tetanus Prophylaxis:

   • Administer tetanus toxoid if vaccination is outdated (>5 years) or status is unknown 1
   • Tetanus, diphtheria, and pertussis (Tdap) is preferred over Tetanus and diphtheria (Td) if the former has not been previously given 1

2. Rabies Post-Exposure Prophylaxis (PEP):

   • Consider the nature of the attack - unprovoked attacks are more likely to indicate rabies 1
   • For bites from healthy domestic dogs, management may include confinement and observation for 10 days 1
   • If rabies PEP is indicated:
     • Previously unvaccinated individuals: 5 doses of rabies vaccine on days 0,3,7,14, and 28, plus Rabies Immune Globulin (RIG) at 20 IU/kg 1
     • Previously vaccinated individuals: vaccine alone without RIG 1
   • Bites that do not break the skin generally do not require rabies PEP 2

Follow-up and Monitoring

• 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
• Consider hospitalization if infection progresses despite appropriate therapy 1
• For hand bites, especially over joints or tendons, consultation with a hand specialist may be necessary 1

Special Considerations

• Children: Most often present with dog bites on the head and neck 2
• Adults: Usually present with dog bites on the extremities and hands 2
• High-risk wounds: Hand bites, particularly over joints or tendons, have higher infection risk 1
• Potential complications: Osteomyelitis, synovitis, nerve or tendon injury, compartment syndromes, post-infectious arthritis, fracture, and bleeding 1