What are the guidelines for managing a bite from a non-vaccinated dog?

Management of Non-Vaccinated Dog Bite Wounds

A non-vaccinated dog that bites a person should be confined and observed daily for 10 days; if this is not possible, the animal should be euthanized immediately and its head submitted for rabies examination. 1

Initial Wound Management

Immediate Wound Care

• Thoroughly wash and flush all bite wounds for approximately 15 minutes with soap and copious amounts of water 2, 3
• Apply an iodine-containing or similarly virucidal topical preparation to the wound 2, 3
• Remove any superficial debris but avoid deeper debridement unless absolutely necessary 2
• Fresh wounds (<8 hours old) may be approximated with Steri-Strips rather than sutures, except for facial wounds which can be closed primarily 2
• Infected wounds should not be closed 2

Antibiotic Prophylaxis

• Administer broad-spectrum antibiotics as dog bite wounds typically contain multiple bacterial species including Pasteurella (50%), Staphylococci, Streptococci, and anaerobes 2
• First-line treatment: Amoxicillin-clavulanate (875/125 mg twice daily for 3-5 days) 2
• For penicillin-allergic patients: Doxycycline (100 mg twice daily), fluoroquinolone plus metronidazole, or clindamycin plus TMP-SMZ 2
• Antibiotic prophylaxis is particularly important for:
  • Bites to the hand or face
  • Deep puncture wounds
  • Immunocompromised patients
  • Wounds with significant tissue damage 2

Rabies Post-Exposure Management

Animal Management

1. For domestic dogs that bite:

   • A healthy dog should be confined and observed daily for 10 days 1
   • Administration of rabies vaccine to the dog is not recommended during the observation period 1
   • Any illness in the animal should be reported immediately to the local health department 1
   • If signs suggestive of rabies develop, the animal should be euthanized and the head submitted for rabies examination 1
   • Any stray or unwanted dog that bites a person may be euthanized immediately and the head submitted for rabies examination 1

2. If the dog cannot be observed or tested:

   • Consider the dog as potentially rabid and proceed with post-exposure prophylaxis 3

Human Post-Exposure Prophylaxis

For previously unvaccinated persons exposed to a potentially rabid dog:

1. Rabies Immune Globulin (RIG):

   • Administer 20 IU/kg body weight 2, 3
   • Infiltrate the full dose around and into the wound if anatomically feasible 2, 3

2. Rabies Vaccine:

   • Administer 5 doses on days 0,3,7,14, and 28 2, 3, 4
   • For previously vaccinated individuals, administer vaccine alone (no RIG) 2, 3

Additional Preventive Measures

Tetanus Prophylaxis

• Administer tetanus toxoid (0.5 mL intramuscularly) if vaccination is outdated (>5 years) or status is unknown 2
• Tetanus, diphtheria, and pertussis (Tdap) is preferred over Tetanus and diphtheria (Td) if the former has not been previously given 2

Wound Care Follow-up

• Schedule follow-up within 24-48 hours to assess for signs of infection 2
• Monitor for increasing redness, swelling, pain, warmth, or drainage 2
• Consider hospitalization if infection progresses despite appropriate therapy 2
• Pay special attention to hand bites, particularly over joints or tendons, as they are at higher risk of complications 2

Special Considerations

High-Risk Situations

• Bites from wild animals (skunks, raccoons, foxes, bats) should be considered rabid until proven otherwise 3
• Provocation of a dog does not eliminate the risk of rabies transmission 5
• Compliance with the full course of rabies vaccination is essential for protection; partial vaccination may not prevent disease 6

Common Pitfalls to Avoid

1. Delayed wound cleaning - Immediate thorough cleaning is critical to reduce infection risk and remove rabies virus
2. Inadequate antibiotic selection - First-generation cephalosporins, penicillinase-resistant penicillins, macrolides, and clindamycin alone have poor activity against Pasteurella multocida and should be avoided 2
3. Failure to report to public health authorities - All dog bites should be reported to local health departments
4. Incomplete rabies prophylaxis - Failure to complete the full course of vaccination puts the patient at continued risk of developing rabies 6
5. Assuming provoked bites are safe - Even dogs that bite under provocation may transmit rabies 5

Remember that rabies is nearly 100% fatal once clinical symptoms develop, making proper post-exposure management critical 7.