What is the appropriate management for a dog bite?

Management of Dog Bites

Dog bites require immediate wound cleansing, thorough irrigation with normal saline, consideration of antibiotic prophylaxis with amoxicillin-clavulanate, and assessment for tetanus and rabies prophylaxis based on the animal's vaccination status and observation capability.

Initial Wound Management

• Wound Cleansing:

  • Thoroughly wash and flush all bite wounds immediately for about 15 minutes with soap and copious amounts of water 1
  • Use sterile normal saline for irrigation to prevent infection 2
  • Avoid high-pressure irrigation as it can spread bacteria to deeper tissue layers 2
  • Remove any foreign bodies and devitalized tissue 3

• Wound Assessment:

  • Examine neurovascular function (pulses, sensation) and range of movement of adjacent joints 3
  • Document findings thoroughly, especially for hand wounds which have higher infection risk 2
  • Consider imaging only if there's suspicion of retained foreign body, damage to underlying structures, or extensive injury 3

Antibiotic Prophylaxis

• Indications for Prophylaxis:

  • Consider for all dog bites, especially high-risk wounds 2:
    • Hand wounds
    • Puncture wounds
    • Wounds >8 hours old
    • Immunosuppressed patients

• Antibiotic Regimen:

  • First-line: Amoxicillin-clavulanate 875/125 mg twice daily for 3-5 days 2, 3
  • For penicillin-allergic patients: Alternative options include 2:
    • Doxycycline 100 mg twice daily
    • Fluoroquinolone plus metronidazole
    • Clindamycin plus TMP-SMZ

Wound Closure

• Primary closure may be performed for cosmetically important areas (face) or gaping wounds if there is low risk of infection 4
• Infected wounds should not be closed 2
• Hand bites, particularly over joints or tendons, may require consultation with a hand specialist 2

Tetanus Prophylaxis

• Administer tetanus toxoid (0.5 mL intramuscularly) if vaccination is outdated (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

Rabies Assessment and Management

Animal Management

• A healthy dog that bites a person should be confined and observed daily for 10 days 5
• Rabies vaccine is not recommended for the animal during the observation period 5
• If the dog shows signs of illness during confinement, it should be evaluated by a veterinarian immediately 5
• If signs suggestive of rabies develop, the animal should be euthanized and its head examined for rabies 5
• Stray or unwanted dogs that bite may be euthanized immediately and tested for rabies 5

Human Post-Exposure Prophylaxis

• Assess need for rabies prophylaxis based on:

  • Vaccination status of the dog
  • Circumstances of the bite
  • Whether the dog can be observed for 10 days 1

• For previously unvaccinated individuals requiring prophylaxis:

  • Administer Rabies Immune Globulin (RIG) at 20 IU/kg body weight, infiltrating the full dose around and into the wound if anatomically feasible 2, 1
  • Give 5 doses of rabies vaccine on days 0,3,7,14, and 28 2

• For previously vaccinated individuals requiring prophylaxis:

  • Administer vaccine alone without RIG 1

Follow-Up Care

• 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

Special Considerations

• Children are most commonly bitten on the head and neck, while adults typically present with bites on extremities and hands 3
• Dog bites may cause crush injuries and soft-tissue avulsion, requiring careful assessment 3
• Potential complications include osteomyelitis, synovitis, nerve or tendon injury, compartment syndromes, and post-infectious arthritis 2
• In most states, physicians are required by law to report animal bites 4