What is the treatment for a dog bite?

Dog Bite Treatment

The essential components of dog bite treatment include immediate and thorough wound cleansing with soap and water, assessment for potential rabies exposure, antibiotic prophylaxis with amoxicillin-clavulanate, and tetanus prophylaxis as indicated. 1

Initial Wound Management

• Immediately wash and flush all bite wounds thoroughly with soap and water for about 15 minutes to reduce the likelihood of infection and rabies transmission 1, 2
• Apply an iodine-containing or similarly virucidal topical preparation to the wound where available 2
• Copiously irrigate the wound with normal saline using a 20-mL or larger syringe or a 20-gauge catheter 3
• Explore the wound for tendon or bone involvement and possible foreign bodies 3
• The decision to suture large wounds should take into account cosmetic factors (especially for facial wounds) and the potential for bacterial infection 1, 4
• Primary surgical repair is generally appropriate for clinically uninfected facial bite wounds, while delayed closure may be better for high-risk or already infected wounds 4

Antibiotic Prophylaxis

• Amoxicillin-clavulanate is the first-line prophylactic antibiotic for dog bite wounds 1, 3
• Alternative oral agents for penicillin-allergic patients include doxycycline or a fluoroquinolone plus an agent active against anaerobes (such as metronidazole or clindamycin) 1, 5
• First-generation cephalosporins, penicillinase-resistant penicillins, macrolides, and clindamycin alone have poor activity against Pasteurella multocida and should be avoided 1
• Intravenous options for severe infections include β-lactam/β-lactamase combinations (such as ampicillin-sulbactam), piperacillin-tazobactam, second-generation cephalosporins, or carbapenems 1
• Antibiotic prophylaxis is particularly important for:
  • Puncture wounds
  • Hand wounds
  • Wounds requiring surgical debridement
  • Wounds involving joints, tendons, ligaments, or fractures
  • Wounds in immunocompromised patients 3, 6

Rabies Post-Exposure Prophylaxis Assessment

• For domestic dogs in the United States:
  • If the dog is healthy and available for 10-day observation, rabies prophylaxis is not needed unless the animal develops clinical signs of rabies 2
  • If the dog is suspected rabid, immediately begin rabies prophylaxis 2
  • If the dog's status is unknown (e.g., escaped), consult public health officials 2
• For rabies post-exposure prophylaxis when indicated:
  • Administer human rabies immune globulin (RIG) and rabies vaccine at different sites 2
  • The vaccine regimen consists of doses on days 0,3,7, and 14 3
  • Previously vaccinated individuals need only the vaccine, not RIG 2

Tetanus Prophylaxis

• Administer tetanus prophylaxis as indicated based on the patient's immunization status 1, 2
• For patients with unknown or incomplete tetanus immunization, provide tetanus toxoid 3

Potential Complications to Monitor

• Infectious complications include septic arthritis, osteomyelitis, subcutaneous abscess formation, tendonitis, and rarely bacteremia 1
• Pain disproportionate to the severity of injury near a bone or joint may suggest periosteal penetration 1
• Hand wounds often have more serious complications than wounds to fleshy parts of the body 1
• Capnocytophaga canimorsus, a fastidious gram-negative rod found in dog saliva, can cause bacteremia and fatal sepsis, especially in patients with asplenia or underlying hepatic disease 1

Microbiology of Dog Bite Wounds

• Dog bite wounds are typically polymicrobial with mixed aerobic and anaerobic bacteria 1, 5
• Common pathogens include:
  • Pasteurella species (isolated from 50% of dog bite wounds)
  • Staphylococci and streptococci (found in ~40% of bites)
  • Anaerobes including Bacteroides species, fusobacteria, Porphyromonas species, and peptostreptococci 1, 5

By following these guidelines for prompt and appropriate treatment of dog bites, the risk of infection and other complications can be significantly reduced, improving patient outcomes.