What is the proper examination and treatment for a cat or dog bite?

Management of Cat and Dog Bites

For cat and dog bites, immediate thorough wound cleaning with soap and water followed by irrigation with a virucidal agent like povidone-iodine solution is essential, along with appropriate antibiotic prophylaxis with amoxicillin/clavulanate, especially for high-risk wounds such as cat bites, hand injuries, and in immunocompromised patients.

Initial Examination and Assessment

• A healthy dog, cat, or ferret that bites a person should be confined and observed daily for 10 days; rabies vaccine should not be administered to the animal during this observation period 1
• Examine the wound for:
  • Depth of penetration and tissue damage 2
  • Involvement of tendons, bones, or joints 2
  • Presence of foreign bodies 2
  • Neurovascular function (pulses, sensation) 2
• Cat bites typically cause deeper puncture wounds with higher infection risk, while dog bites often result in crush injuries and soft tissue avulsion 2
• Children most commonly present with bites to the head and neck, while adults typically have bites to extremities and hands 2

Wound Management

• Immediate and thorough washing of all bite wounds with soap and water is crucial for preventing rabies and bacterial infections 1
• Irrigate wounds copiously with normal saline using a 20-mL or larger syringe or a 20-gauge catheter 3
• Apply a virucidal agent such as povidone-iodine solution 1
• Remove any foreign bodies and devitalized tissue 2
• Consider wound closure based on:
  • Location (facial wounds may be closed for cosmetic reasons) 3
  • Time since injury (wounds >24 hours old should generally not be closed) 4
  • Risk of infection (high-risk wounds should be left open) 4

Antibiotic Prophylaxis

• Antibiotic prophylaxis should be considered for all bites, particularly for:
  • Cat bites (higher infection risk) 5, 6
  • Puncture wounds 3
  • Wounds to the hand 3, 4
  • Immunocompromised patients 3
• Amoxicillin/clavulanate is the first-line prophylactic antibiotic for both dog and cat bites 3, 5, 2
• Pasteurella multocida is isolated in over 50% of cat bites and 20-30% of dog bites, requiring appropriate antibiotic coverage 5, 6

Rabies and Tetanus Prophylaxis

• Assess the need for rabies prophylaxis with any animal bite, as even domestic animals may be unvaccinated 3
• For rabies prophylaxis, when indicated:
  • Administer rabies immune globulin at presentation 3
  • Provide vaccination on days 0,3,7, and 14 3
• Evaluate tetanus immunization status and provide tetanus prophylaxis as needed 5, 2
• Bites that do not break the skin generally do not require rabies postexposure prophylaxis 2

Management of Stray or Wild Animals

• Any stray or unwanted dog, cat, or ferret that bites a person should be euthanized immediately and the head submitted for rabies examination 1
• Wild mammals and hybrids that bite humans should be considered for euthanasia and rabies examination 1
• A person bitten by any wild mammal should immediately report to a physician for evaluation of rabies prophylaxis needs 1

Special Considerations for Delayed Presentation

• Patients presenting >24 hours after a bite have higher risk of complications, especially with hand and forearm wounds 4
• Look for signs of infection:
  • Limited and painful mobilization of fingers and wrist 4
  • Swelling and redness in the bite area 4
  • Possible tendon lesions or purulent flexor tenosynovitis 4
• Patients with signs of tissue infection may require hospital admission for aggressive treatment 4

Reporting Requirements

• In most states, physicians are required by law to report animal bites to appropriate authorities 3