What is the treatment for a patient with a puncture wound and 2 cm abrasion from a dog bite?

Treatment of Dog Bite Wounds with Puncture and Abrasion

For a patient with a puncture wound and 2 cm abrasion from a dog bite, thorough wound irrigation, antimicrobial prophylaxis with amoxicillin-clavulanate, and tetanus prophylaxis are strongly recommended as the standard of care. 1, 2

Initial Wound Management

• Thoroughly irrigate the wound with sterile normal saline or running tap water until all visible debris and foreign matter are removed 1, 2
• Avoid antiseptic agents such as povidone-iodine for irrigation as they show no benefit over saline or tap water 1
• Perform careful debridement of devitalized tissue to reduce infection risk 2, 3
• Puncture wounds require special attention as they are at higher risk of infection due to their depth and difficulty to clean 2, 4

Wound Closure Considerations

• Facial wounds may receive primary closure after thorough irrigation and debridement for optimal cosmetic outcomes 2
• For non-facial wounds, especially puncture wounds, avoid primary closure to reduce infection risk 2, 3
• Consider loose approximation rather than full closure for non-facial wounds 2
• Hand wounds should generally not be closed primarily due to high infection risk 2, 5

Antibiotic Prophylaxis

• Administer amoxicillin-clavulanate 875/125 mg twice daily as it provides coverage against both aerobic and anaerobic bacteria commonly found in dog bite wounds 1, 2
• Prophylactic antibiotics are particularly indicated for puncture wounds, which are considered high-risk 1, 4
• Alternative options for penicillin-allergic patients include:
  • Doxycycline 100 mg twice daily (excellent activity against Pasteurella multocida) 1
  • Moxifloxacin 400 mg daily (good coverage for both aerobes and anaerobes) 1
  • Clindamycin 300 mg three times daily plus a fluoroquinolone (for broader coverage) 1

Tetanus Prophylaxis

• Administer tetanus toxoid to patients without vaccination within the past 10 years 1, 2
• Tetanus, diphtheria, and pertussis (Tdap) is preferred over Tetanus and diphtheria (Td) if the former has not been previously given 1

Rabies Considerations

• Consult with local health officials to determine if rabies post-exposure prophylaxis should be initiated 1, 2
• A healthy domestic dog that bites a person should be confined and observed for 10 days 2

Follow-up Care

• Schedule follow-up within 48-72 hours to assess for signs of infection and evaluate wound healing 2
• Instruct the patient to seek immediate medical attention if they develop redness, swelling, increased pain, foul-smelling drainage, or fever 1, 6
• Apply an occlusive dressing to promote wound healing after thorough cleaning 1

Common Pitfalls to Avoid

• Failing to adequately irrigate and debride the wound 3
• Using first-generation cephalosporins or penicillinase-resistant penicillins alone for prophylaxis (poor activity against Pasteurella multocida) 2
• Closing puncture wounds primarily, especially on hands 2, 5
• Delaying treatment beyond 8 hours, which significantly increases infection risk 2, 5