What is the proper treatment for a dog bite?

Proper Treatment for Dog Bites

The proper treatment for a dog bite includes immediate and thorough wound cleansing with soap and water for 15 minutes, assessment for rabies exposure risk, 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 approximately 15 minutes to reduce infection risk and potential rabies transmission 1, 2
• Consider using a virucidal agent such as povidone-iodine solution for irrigation 3, 2
• Carefully examine the wound for:
  • Tendon, bone, or joint involvement (indicated by pain disproportionate to the injury) 3
  • Neurovascular function (pulses, sensation) 4
  • Range and movement of adjacent joints 4
• Debride any devitalized tissue and remove foreign bodies 4
• The decision to suture wounds should consider:
  • Timing (wounds seen within 8 hours may be closed if properly cleaned) 3
  • Location (facial wounds can often be closed primarily after meticulous cleaning) 3
  • Risk of infection (infected wounds should not be closed) 3

Antibiotic Prophylaxis

• Amoxicillin-clavulanate is the first-line prophylactic antibiotic for dog bite wounds 1, 5
• Antibiotic prophylaxis is particularly important for:
  • Hand wounds 1, 6
  • Puncture wounds 5
  • Wounds involving joints, tendons, ligaments, or fractures 1
  • Immunocompromised patients 5
• For penicillin-allergic patients, alternatives include:
  • Doxycycline 1
  • A fluoroquinolone plus an agent active against anaerobes 1
• Avoid first-generation cephalosporins, penicillinase-resistant penicillins, macrolides, and clindamycin alone as they have poor activity against Pasteurella species 1
• For severe infections requiring intravenous therapy, options include:
  • β-lactam/β-lactamase combinations 1
  • Piperacillin-tazobactam 1
  • Second-generation cephalosporins 1
  • Carbapenems 1

Rabies and Tetanus Prophylaxis

• Assess the need for rabies prophylaxis based on:
  • Vaccination status of the dog 3, 2
  • Circumstances of the bite (unprovoked bites are more concerning) 3, 2
  • Whether the animal can be observed for 10 days 3, 2
• If the dog is healthy and available for 10-day observation, rabies prophylaxis can be delayed unless the animal develops clinical signs of rabies 2
• If the dog is rabid, suspected rabid, or unknown/escaped, immediately begin rabies prophylaxis 2
• Rabies post-exposure prophylaxis consists of:
  • Rabies immune globulin at presentation 2
  • Rabies vaccine on days 0,3,7, and 14 2
• Administer tetanus prophylaxis as indicated based on the patient's immunization status 3, 2

Microbiology and Infection Risk

• Dog bite wounds are typically polymicrobial with mixed aerobic and anaerobic bacteria 1
• Common pathogens include:
  • Pasteurella species (isolated from 50% of dog bite wounds) 1
  • Staphylococci and streptococci (found in ~40% of bites) 1
  • Anaerobes including Bacteroides species, fusobacteria, Porphyromonas species, and peptostreptococci 1
• Capnocytophaga canimorsus can cause bacteremia and fatal sepsis, especially in patients with asplenia or underlying hepatic disease 3, 1
• The estimated cumulative incidence of infection in untreated dog bite wounds is 16% 7
• Prophylactic antibiotics reduce the incidence of infection (relative risk 0.56) 7

Special Considerations

• Hand wounds require special attention due to:
  • Multiple small compartments with thin soft tissue covering over bones and joints 6
  • Higher risk of infection compared to bites on the arm, leg, or face 6
  • Potential for significant morbidity if improperly managed 6
• Children most often present with dog bites on the head and neck, while adults usually present with bites on extremities and hands 4
• Dog bites may cause crush injuries and soft-tissue avulsion requiring more extensive treatment 4
• In most states, physicians are required by law to report animal bites 5