What is the proper care and treatment for a dog bite?

Proper Care and Treatment for Dog Bite Wounds

Dog bite wounds require immediate thorough wound cleansing with normal saline, appropriate antibiotic prophylaxis with amoxicillin-clavulanate for high-risk wounds, and consideration of rabies and tetanus prophylaxis to prevent infection and optimize outcomes. 1

Initial Wound Management

• Immediate gentle irrigation with water or dilute water povidone-iodine solution should be performed to markedly decrease the risk of bacterial infection 2
• Wounds should be copiously irrigated with sterile normal saline using a 20-mL or larger syringe or a 20-gauge catheter 1, 3
• Care should be taken not to damage skin or tissues during cleansing 2
• Wounds should be explored for tendon or bone involvement and possible foreign bodies 3

Wound Closure Considerations

• Facial wounds may receive primary closure after thorough irrigation and debridement for optimal cosmetic outcomes 1
• Non-facial wounds generally should not be closed primarily but may be approximated rather than fully closed to reduce infection risk 1
• Suturing should be avoided when possible, especially for hand wounds which have higher infection risk 2, 1

Infection Risk Assessment

• Dog bite wounds have significant infection potential with approximately 60% yielding mixed aerobic and anaerobic bacteria 1
• Pasteurella species are isolated from 50% of dog bite wounds, along with staphylococci and streptococci in approximately 40% 1
• Higher infection risk factors include:
  • Hand injuries 1
  • Crushed tissue 1
  • Delayed presentation (>8 hours after injury) 1
  • Immunocompromised status 1
  • Deep puncture wounds 4

Antibiotic Prophylaxis

• Amoxicillin-clavulanate is the preferred first-line antibiotic as it provides coverage against both aerobic and anaerobic bacteria commonly found in dog bite wounds 1, 3, 4
• Prophylactic antibiotics should be considered for:
  • Immunocompromised patients 1
  • Asplenic patients 1
  • Patients with advanced liver disease 1
  • Hand wounds 1
  • Moderate to severe wounds 5
  • Deep puncture wounds 4
  • Wounds with delayed presentation (>8 hours) 1
• Standard course is 3-5 days of antibiotic therapy 1, 5
• Meta-analysis shows prophylactic antibiotics reduce infection incidence in dog bite wounds (relative risk 0.56) 6

Tetanus Prophylaxis

• Tetanus prophylaxis should be administered to patients without vaccination within the past 10 years 1, 3
• Consider tetanus immune globulin for patients with incomplete vaccination history 4

Rabies Prophylaxis Considerations

• Consultation with local health officials is recommended to determine if rabies post-exposure prophylaxis should be initiated 1
• A healthy domestic dog that bites a person should be confined and observed for 10 days 1, 5
• If rabies prophylaxis is indicated, it should include both rabies immune globulin and vaccine, administered as soon as possible 2
• The standard regimen includes immunoglobulins at presentation and vaccine on days 0,3,7, and 14 5
• Bites that don't break the skin generally don't require rabies prophylaxis 4

Follow-up Care

• All patients should be seen in follow-up within 48-72 hours to assess for signs of infection and evaluate wound healing progress 1
• Signs of infection to monitor include increasing pain, swelling, redness, warmth, or purulent drainage 4

Common Pitfalls to Avoid

• Closing non-facial wounds primarily, especially hand wounds 1
• Using first-generation cephalosporins or penicillinase-resistant penicillins alone for prophylaxis (poor activity against Pasteurella multocida) 1
• Delaying wound irrigation and cleansing 2
• Failing to consider rabies prophylaxis, even for domestic animals that may be unvaccinated 1
• Neglecting to report the bite to appropriate authorities (required by law in most states) 3