What is the treatment for a dog bite from a dog with no vaccinations?

Treatment for Dog Bite from an Unvaccinated Dog

Immediate treatment for a dog bite from an unvaccinated dog requires thorough wound cleaning with soap and water, followed by rabies post-exposure prophylaxis consisting of rabies immune globulin and a series of rabies vaccinations, along with tetanus prophylaxis and evaluation for antibiotic therapy. 1

Immediate Wound Management

• Immediate and thorough washing of all bite wounds and scratches with soap and water is crucial for preventing rabies and bacterial infections 1
• Wound cleansing has been shown to markedly reduce the likelihood of rabies transmission 1
• Evaluate the wound for skin loss, joint penetration, and tendon, nerve, and vascular injuries 2
• The decision to suture large wounds should consider cosmetic factors and potential for bacterial infections 1
• For heavily contaminated wounds or those on the hand, delayed primary closure may be preferred 3

Rabies Post-Exposure Prophylaxis (PEP)

Assessment of Rabies Risk

• An unvaccinated dog with unknown rabies status should be considered a potential rabies risk 1
• If possible, the dog should be confined and observed for 10 days under veterinary supervision 1
• If the dog cannot be observed (stray or unwanted), it should be euthanized and tested for rabies if possible 1
• An unprovoked attack is more likely to indicate that the animal is rabid compared to a provoked attack 1

Rabies PEP Components

• Rabies PEP should begin within 24 hours of exposure but can be initiated even months later if necessary 1
• The essential components include:
  1. Human Rabies Immune Globulin (HRIG): One dose at the beginning of PEP 1
  2. Rabies vaccine: A regimen of five 1-ml doses given intramuscularly on days 0,3,7,14, and 28 1
• For adults, the vaccine should always be administered in the deltoid area; for children, the anterolateral aspect of the thigh is also acceptable 1
• The gluteal area should never be used for vaccine administration 1
• If the dog remains healthy during the 10-day observation period, PEP can be discontinued 1

Additional Prophylaxis and Treatment

• Tetanus prophylaxis should be administered if not up-to-date 1, 4
• Consider antibiotic therapy to prevent bacterial infection, particularly for:
  • Deep puncture wounds
  • Wounds with significant tissue damage
  • Hand or face wounds
  • Wounds in immunocompromised patients 2, 3
• In one study, patients who received antibiotic prophylaxis had no cases of wound infection 5

Special Considerations

• Children are at higher risk for dog bites, especially facial injuries, which may require more complex reconstruction 6, 5
• Patients under the influence of alcohol may be at higher risk for dog bites, particularly from unknown dogs 5
• Psychological support may be needed for bite victims, especially children, to reduce long-term impacts 6

Public Health Reporting

• Dog bites from unvaccinated animals should be reported to local health departments 1
• Health departments can assist with rabies risk assessment and management decisions 1

Prevention of Future Bites

• Education about dog behavior and safe interaction is important, especially for children 6
• All pet dogs should be vaccinated against rabies to prevent transmission 7
• Supervision of child-dog interactions is essential to prevent bites 6