What is the treatment for a dog scratch?

Treatment for Dog Scratches

For dog scratches, thorough wound cleansing with sterile normal saline or copious irrigation with warm potable water is the primary treatment, followed by antibiotic prophylaxis with amoxicillin-clavulanate for high-risk wounds. 1

Initial Wound Management

1. Immediate Wound Cleansing

   • Thoroughly irrigate the wound with a large volume of warm or room temperature potable water to remove foreign matter 1
   • Consider povidone-iodine solution for irrigation as a virucidal agent 1
   • Remove any superficial debris but avoid deeper debridement unless necessary 1

2. Wound Assessment

   • Evaluate for:
     • Depth of penetration
     • Proximity to joints, tendons, or bones
     • Signs of infection (redness, swelling, warmth, drainage)
     • Foreign material in the wound
   • Fresh wounds (<8 hours old) may be approximated with Steri-Strips rather than sutures, except for facial wounds which can be closed primarily 1

Antibiotic Prophylaxis

Indications for antibiotic prophylaxis:

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

First-line antibiotic regimen:

• Amoxicillin-clavulanate 875/125 mg twice daily for 3-5 days 1

For penicillin-allergic patients:

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

Tetanus Prophylaxis

• Administer tetanus toxoid (0.5 mL intramuscularly) if vaccination is outdated (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

Rabies Consideration

• Assess the need for rabies prophylaxis based on:
  • Vaccination status of the dog
  • Circumstances of the scratch
  • Local rabies prevalence
• If indicated, administer Rabies Immune Globulin (RIG) and vaccine, with RIG at 20 IU/kg body weight 1
• Previously unvaccinated individuals should receive 5 doses of rabies vaccine on days 0,3,7,14, and 28 1

Follow-up Care

• Elevate the injured area, especially if swollen, to accelerate healing 1
• Schedule follow-up within 24-48 hours to assess for signs of infection 1
• Monitor for increasing redness, swelling, pain, warmth, or drainage 1

Special Considerations

High-Risk Wounds

• Hand wounds are at higher risk of infection and complications, with potential for joint or tendon involvement 1
• Consider consultation with a specialist if joint spaces or tendons are involved 1

Potential Complications

• Watch for signs of infection, which typically develops within 12-24 hours after the injury 2
• Pasteurella multocida is a common pathogen in dog scratches and bites, causing rapid-onset cellulitis 2
• Other potential complications include osteomyelitis, synovitis, nerve or tendon injury 1

Infection Risk

• The cumulative incidence of infection in untreated dog bite wounds is approximately 16% 3
• Prophylactic antibiotics reduce the incidence of infection in high-risk wounds 3

Dog scratches, while often less severe than bites, still require proper assessment and treatment to prevent infection and other complications. The treatment approach should be based on wound characteristics and patient risk factors.