What is the recommended treatment for a dog bite?

Dog Bite Treatment Protocol

The recommended treatment for dog bites includes thorough wound cleansing with copious irrigation, assessment for rabies risk, tetanus prophylaxis, consideration of antibiotic prophylaxis (particularly for high-risk wounds), and appropriate wound closure decisions based on wound characteristics. 1

Initial Wound Management

1. Wound Cleansing:

   • Thoroughly irrigate with large volumes of warm or room temperature potable water 1
   • Use povidone-iodine solution as a virucidal agent for irrigation 1
   • Use a 20-mL or larger syringe or a 20-gauge catheter for effective irrigation 2
   • Remove any superficial debris but avoid deeper debridement unless absolutely necessary 1

2. Wound Assessment:

   • Explore the wound for tendon or bone involvement and possible foreign bodies 2
   • Assess for potential complications including nerve or tendon injury 1
   • Pay special attention to hand bites, particularly over joints or tendons, which are at higher risk of infection 1
   • Consider consultation with a hand specialist if joint spaces or tendons are involved 1

Rabies Post-Exposure Prophylaxis

1. Risk Assessment:

   • Assess circumstances of the bite (unprovoked attacks are more likely to indicate rabies) 1
   • Check vaccination status of the dog 1
   • A healthy domestic dog that bites should be confined and observed for 10 days 1

2. Prophylaxis Protocol:

   • If rabies risk exists, initiate post-exposure prophylaxis as soon as possible 1
   • For 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 body weight 1
   • For previously vaccinated individuals: vaccine alone without RIG 1
   • Infiltrate RIG around and into the wound if anatomically feasible 1

Antibiotic Prophylaxis

1. Indications for Antibiotics:

   • High-risk wounds: puncture wounds (infection risk 2.8 times higher) 3
   • Wounds that are closed during treatment (3.1 times higher infection risk) 3
   • Bites to the hand or face 1
   • Immunocompromised patients 1
   • Wounds with significant tissue damage 1

2. Antibiotic Regimen:

   • First-line: Amoxicillin-clavulanate (875/125 mg twice daily for 3-5 days) 1, 2
   • For penicillin-allergic patients: doxycycline (100 mg twice daily), fluoroquinolone plus metronidazole, or clindamycin plus TMP-SMZ 1

Wound Closure Decisions

• 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
• Consider closure if cosmetically favorable, such as wounds on the face or gaping wounds 2

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

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

Important Considerations

• The overall infection rate for dog bites is approximately 5.2%, but can be as high as 16% without proper treatment 4, 3
• Prophylactic antibiotics reduce the incidence of infection in dog bite wounds (relative risk 0.56) 4
• Dog bites account for 1% of all emergency department visits in the United States 2
• In most states, physicians are required by law to report animal bites 2