What is the treatment for a pediatric dog bite?

Treatment for Pediatric Dog Bites

Immediate wound cleansing with soap and water for 15 minutes is the most critical first step in treating pediatric dog bites, followed by appropriate antibiotic prophylaxis with amoxicillin-clavulanate, tetanus prophylaxis if needed, and assessment for rabies exposure. 1

Initial Wound Management

• Immediately wash and flush all bite wounds thoroughly with soap and water for approximately 15 minutes to reduce infection risk and potential rabies transmission 1, 2

• Consider applying an iodine-containing or similarly virucidal topical preparation to the wound where available 2

• Wounds should be carefully examined for:

  • Tendon or bone involvement 1
  • Foreign bodies 3
  • Potential joint penetration (pain disproportionate to injury near a bone or joint may suggest periosteal penetration) 4, 1

• The decision to suture wounds should consider:

  • Cosmetic factors (facial wounds may be closed if seen early and properly cleaned) 4, 1
  • Risk of bacterial infection (infected wounds should not be left open) 4
  • Timing (wounds seen >8 hours after injury should generally not be closed primarily) 4

Antibiotic Prophylaxis

• Amoxicillin-clavulanate is the first-line prophylactic antibiotic for dog bite wounds 1, 5

• Alternative oral agents for penicillin-allergic patients include:

  • Doxycycline 1
  • Fluoroquinolone plus an agent active against anaerobes 1
  • Clindamycin plus a fluoroquinolone 5

• Antibiotic prophylaxis is particularly important for:

  • Hand wounds 1, 3
  • Deep wounds with evidence of edema or crushing 6
  • Facial bites 6
  • Wounds over tendons or bones 1, 6
  • Immunocompromised patients 6

• First-generation cephalosporins, penicillinase-resistant penicillins, macrolides, and clindamycin alone should be avoided due to poor activity against Pasteurella multocida 1

Rabies Prophylaxis Considerations

• Assess the need for rabies prophylaxis based on:

  • Vaccination status of the dog 4, 2
  • Circumstances of the bite (unprovoked attacks are more likely to indicate rabies) 4, 2
  • Whether the dog can be observed for 10 days 2

• If rabies prophylaxis is indicated:

  • Administer both rabies immune globulin (RIG) and rabies vaccine 4
  • The first dose of vaccine should be given as soon as possible after exposure 4
  • Additional doses should be given on days 3,7,14, and 28 after the first vaccination 4

• Consult local public health authorities to determine the need for rabies prophylaxis based on regional epidemiology 2, 3

Tetanus Prophylaxis

• Assess tetanus immunization status and administer tetanus prophylaxis as indicated 4, 1, 2
• For patients with unknown or incomplete tetanus immunization, administer tetanus toxoid (0.5 mL intramuscularly) 4

Special Considerations for Children

• Children under 5 years of age suffer the most severe injuries, particularly to the head and neck region 7
• Children are the most frequently bitten subjects, accounting for the majority of dog bite cases 6, 8
• Hand wounds in children require special attention as they often have more serious complications than wounds to fleshy parts of the body 1

Potential Complications to Monitor

• Infectious complications include:

  • Septic arthritis 4, 1
  • Osteomyelitis 4, 1
  • Subcutaneous abscess formation 1
  • Tendonitis 1
  • Bacteremia (rare) 1

• Dog bite wounds are typically polymicrobial with mixed aerobic and anaerobic bacteria:

  • Pasteurella species (found in 50% of dog bite wounds) 1, 5
  • Staphylococci and streptococci (found in ~40% of bites) 1, 5
  • Anaerobes including Bacteroides species, fusobacteria, Porphyromonas species, and peptostreptococci 1, 5

• Capnocytophaga canimorsus can cause bacteremia and fatal sepsis, especially in patients with asplenia or underlying hepatic disease 1