What is the recommended treatment for a dog bite?

Dog Bite Treatment Guidelines

The recommended treatment for a dog bite includes immediate thorough wound cleansing with soap and water for 15 minutes, proper wound assessment, antibiotic prophylaxis with amoxicillin-clavulanate, and evaluation for tetanus and rabies prophylaxis as needed. 1, 2

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 additional wound irrigation 3
• Carefully examine wounds for:
  • Tendon or bone involvement 1, 2
  • Potential joint penetration (indicated by pain disproportionate to injury near a bone or joint) 1, 2
  • Foreign bodies or devitalized tissue that should be removed 4
• Document neurovascular function (pulses, sensation) and range of movement of adjacent joints 4

Wound Closure Considerations

• The decision to suture wounds should consider:
  • Cosmetic factors - facial wounds may be closed if seen early and properly cleaned 1, 2
  • Risk of bacterial infection - heavily contaminated wounds should not be closed 5
  • Timing of the wound - fresh wounds are safer to close than older ones 1
  • Location - hand wounds generally should not be primarily closed due to higher infection risk 2, 5

Antibiotic Prophylaxis

• Amoxicillin-clavulanate is the first-line prophylactic antibiotic for dog bite wounds 1, 2, 4
• Alternative oral agents for penicillin-allergic patients include:
  • Doxycycline 1, 2
  • Fluoroquinolone plus an agent active against anaerobes 1, 2
  • Clindamycin plus a fluoroquinolone 1
• Avoid first-generation cephalosporins, penicillinase-resistant penicillins, macrolides, and clindamycin alone as they have poor activity against Pasteurella multocida 2
• Antibiotic prophylaxis is particularly important for:
  • Hand wounds 1, 2
  • Wounds over tendons or bones 1, 2
  • Immunocompromised patients 1
  • Deep puncture wounds 6

Tetanus Prophylaxis

• Assess tetanus immunization status for all dog bite patients 1, 7
• For patients with unknown or fewer than three doses of tetanus toxoid:
  • Administer tetanus toxoid for all wounds 7
  • For contaminated wounds, also administer Tetanus Immune Globulin (TIG) 7
• For patients with three or more previous doses:
  • Administer tetanus toxoid if more than 10 years since last dose for clean, minor wounds 7
  • Administer tetanus toxoid if more than 5 years since last dose for contaminated wounds 7

Rabies Prophylaxis

• Assess the need for rabies prophylaxis based on:
  • Vaccination status of the dog 1, 2
  • Circumstances of the bite 1, 2
  • Whether the dog can be observed for 10 days 1, 3
• If rabies prophylaxis is indicated:
  • Administer both rabies immune globulin and rabies vaccine 1, 3
  • Give the first dose of vaccine as soon as possible after exposure 1, 3
• Bites that don't break the skin generally don't require rabies prophylaxis 4

Potential Complications to Monitor

• Infectious complications include:
  • Septic arthritis, osteomyelitis, subcutaneous abscess formation 1, 2
  • Tendonitis and bacteremia 1, 2
  • Capnocytophaga canimorsus bacteremia and sepsis (especially in patients with asplenia or liver disease) 1, 2
• Common pathogens in dog bite wounds include:
  • Pasteurella species (found in 50% of dog bite wounds) 2
  • Staphylococci and streptococci (found in ~40% of bites) 2
  • Anaerobes including Bacteroides species, fusobacteria, Porphyromonas species, and peptostreptococci 2

Special Considerations

• Children are at highest risk for dog bites, with facial injuries being common 6, 5
• Hand wounds often have more serious complications than wounds to fleshy parts of the body 2
• Almost half of all dog bites involve an animal owned by the victim's family or neighbors 8
• The estimated risk of infection without antibiotic prophylaxis is approximately 16%, with prophylactic antibiotics reducing this risk significantly 9