Management of Dog Bites: Mupirocin with Augmentin

For dog bites, mupirocin is not routinely recommended alongside Augmentin (amoxicillin-clavulanate) as standard therapy. 1

First-Line Antibiotic Therapy

Amoxicillin-clavulanate (Augmentin) 875/125 mg twice daily is the preferred oral antibiotic for dog bites, providing coverage against both aerobic and anaerobic bacteria commonly found in these wounds 1
This antibiotic effectively targets the polymicrobial nature of dog bite infections, including Pasteurella species (found in 50% of dog bites), staphylococci, streptococci, and anaerobes 1
The combination of amoxicillin with clavulanate specifically addresses the beta-lactamase producing organisms often present in animal bites 1

Mupirocin (Bactroban) is primarily indicated for impetigo and has greatest activity against gram-positive cocci such as Staphylococcus aureus and Streptococcus pyogenes 2
Current guidelines from the Infectious Diseases Society of America do not recommend adding mupirocin to systemic antibiotic therapy for dog bites 1
The polymicrobial nature of dog bite wounds, including multiple aerobic and anaerobic bacteria, requires systemic antibiotic coverage rather than topical therapy alone 1

For penicillin-allergic patients, alternative options include:
- Doxycycline 100 mg twice daily (excellent activity against Pasteurella multocida) 1
- Fluoroquinolones (e.g., ciprofloxacin, levofloxacin) plus metronidazole for anaerobic coverage 1
- Moxifloxacin 400 mg daily as monotherapy (covers both aerobes and anaerobes) 1

Thorough wound cleansing with irrigation is essential and can significantly reduce infection risk 1
Debridement of devitalized tissue while preserving viable tissue is important 3
Tetanus prophylaxis should be administered if vaccination is not current within the past 10 years 1
Consider rabies prophylaxis in consultation with local health officials 3
Primary closure may be appropriate for facial wounds, but delayed closure should be considered for high-risk or already infected wounds 4

Higher risk wounds that definitely warrant antibiotic prophylaxis include:
- Puncture wounds (especially if penetrating bone, tendon, or joint)
- Facial bites
- Hand and foot injuries
- Wounds in immunocompromised or asplenic patients 5
Extended antibiotic therapy (2-4 weeks) may be necessary if complications such as osteomyelitis develop 3

Using first-generation cephalosporins, macrolides, or clindamycin alone has poor activity against Pasteurella multocida commonly found in dog bites 3
Inadequate irrigation and debridement significantly increases infection risk 3
Failing to consider tetanus and rabies prophylaxis 1
Relying on topical antibiotics alone for dog bite wounds is insufficient given the polymicrobial nature and potential depth of these injuries 1