What is the treatment for a dog bite?

Treatment for Dog Bite

The treatment for dog bite wounds requires immediate thorough washing with soap and water for 15 minutes, followed by antibiotic prophylaxis with amoxicillin-clavulanate, and assessment for rabies and tetanus prophylaxis. 1

Initial Wound Management

• Immediately wash and flush all bite wounds thoroughly with soap and water for about 15 minutes to reduce infection risk and potential rabies transmission 1
• Examine the wound for foreign bodies, devitalized tissue, and assess neurovascular function and joint movement 2
• Copiously irrigate 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 wounds should consider cosmetic factors and infection risk - wounds on the face or gaping wounds may be closed if risk of infection is low 1, 3

Antibiotic Prophylaxis

• Amoxicillin-clavulanate is the recommended first-line prophylactic antibiotic for dog bite wounds 4, 1
• Preemptive antimicrobial therapy for 3-5 days is strongly recommended for patients who:
  • Are immunocompromised
  • Are asplenic
  • Have advanced liver disease
  • Have preexisting or resultant edema of the affected area
  • Have moderate to severe injuries, especially to the hand or face
  • Have injuries that may have penetrated the periosteum or joint capsule 4
• For penicillin-allergic patients, alternative options include:
  • Doxycycline (100 mg twice daily orally)
  • A fluoroquinolone plus an agent active against anaerobes 1
  • Clindamycin (300 mg three times daily orally) with trimethoprim-sulfamethoxazole (160-800 mg twice daily) 4
• Intravenous options for severe infections include ampicillin-sulbactam, piperacillin-tazobactam, or carbapenems 4, 1

Rabies Prophylaxis

• Consult with local health officials to determine if rabies vaccination should be initiated 4
• Postexposure prophylaxis consists of rabies immune globulin at presentation and vaccination on days 0,3,7, and 14 4, 3
• Bites that do not break the skin generally do not require rabies postexposure prophylaxis 2
• Exposures to dogs in rabies-endemic areas outside the United States carry a high risk and may warrant immediate initiation of postexposure treatment 4

Tetanus Prophylaxis

• Administer tetanus prophylaxis based on the patient's immunization status 1, 3
• For patients with unknown or incomplete tetanus immunization status, tetanus toxoid should be administered 3

Special Considerations

• Hand wounds require particular attention as they have higher risk of complications including infections of tendon sheaths and joints 1, 5
• Children most often present with dog bites on the head and neck, while adults usually present with bites on extremities and hands 2
• Monitor for infectious complications such as 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
• Capnocytophaga canimorsus can cause bacteremia and fatal sepsis, especially in asplenic patients or those with 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 (found in 50% of dog bite wounds), staphylococci, streptococci, and various anaerobes including Bacteroides, fusobacteria, and Porphyromonas species 1, 5