Do I need stitches after a dog bite?

Management of Dog Bite Wounds

Dog bite wounds should be thoroughly cleaned with soap and water and evaluated for closure, with primary suturing reserved for facial wounds or those seen early and properly cleaned, while prophylactic antibiotics should be considered for high-risk wounds. 1, 2

Initial Wound Management

• Immediately wash and flush all dog bite wounds thoroughly with soap and water for approximately 15 minutes to reduce infection risk and potential rabies transmission 1, 2
• Gentle irrigation with copious amounts of fluid (water or saline) is recommended to minimize bacterial and rabies infections 3
• Use a 20-mL or larger syringe or a 20-gauge catheter for effective irrigation 4
• Examine the wound carefully for:
  • Tendon or bone involvement 1
  • Joint penetration (indicated by pain disproportionate to injury near a bone or joint) 1
  • Possible foreign bodies 4
  • Neurovascular function (pulses, sensation) 5

Wound Closure Considerations

• Primary closure should be considered for:
  • Facial wounds (for cosmetic reasons) 1, 2
  • Wounds seen early (within 8 hours) and properly cleaned 1, 4
  • Gaping wounds that would benefit from cosmetic closure 4
• Avoid primary closure for:
  • Puncture wounds 5
  • Hand wounds (high infection risk) 3
  • Wounds older than 8-12 hours (typically have established infection) 3
  • Heavily contaminated wounds 6

Antibiotic Prophylaxis

• Amoxicillin-clavulanate is the first-line prophylactic antibiotic for dog bite wounds 3, 1, 4
• Alternative oral agents for penicillin-allergic patients include:
  • Doxycycline 3, 1
  • Fluoroquinolone plus an agent active against anaerobes (such as metronidazole) 3, 1
• Antibiotic prophylaxis is particularly important for:
  • Hand wounds 1, 7
  • Puncture wounds 4
  • Wounds over tendons or bones 1
  • Immunocompromised patients 1, 5

Additional Considerations

• Assess tetanus immunization status and administer tetanus prophylaxis as indicated 1, 2
• Evaluate the need for rabies prophylaxis based on:
  • Vaccination status of the dog 1
  • Whether the dog can be observed for 10 days 1
  • Circumstances of the bite 1, 2
• If rabies prophylaxis is indicated, administer both rabies immune globulin (20 IU/kg body weight) and rabies vaccine, with doses on days 0,3,7,14, and 28 1, 2

Potential Complications to Monitor

• Infectious complications include:
  • Septic arthritis and osteomyelitis 1
  • Subcutaneous abscess formation 1
  • Tendonitis 1
  • Bacteremia 1
• Common pathogens include:
  • Pasteurella species (found in 50% of dog bite wounds) 3, 7
  • Staphylococci and streptococci (found in ~40% of bites) 3
  • Anaerobic bacteria 3
  • Capnocytophaga canimorsus (can cause fatal sepsis, especially in patients with asplenia or liver disease) 3, 1

Clinical Pearls and Pitfalls

• Dog bites account for most animal bites in the United States, with children being the most common victims 4, 5
• Dog bites may cause crush injuries and soft-tissue avulsion, requiring careful assessment of underlying structures 5
• Wounds that appear trivial initially may develop serious infections if not properly managed 7
• In most states, physicians are required by law to report animal bites 4
• Avoid first-generation cephalosporins, penicillinase-resistant penicillins, macrolides, and clindamycin alone as they have poor activity against Pasteurella multocida 3