Recommended Antibiotic Dosages for Dog Bite Treatment
Amoxicillin-clavulanate (875/125 mg twice daily for adults) is the first-line antibiotic therapy for dog bite wounds, providing coverage against both aerobic and anaerobic bacteria commonly found in these infections. 1
First-Line Antibiotic Therapy
- For adults, amoxicillin-clavulanate should be administered at a dose of 875/125 mg orally twice daily 1
- For pediatric patients, the recommended dose is 45 mg/kg/day divided every 12 hours 1
- Treatment duration should be 3-5 days for prophylactic therapy in high-risk wounds 1
- For established infections, a 7-10 day course is typically recommended 2
Microbiology of Dog Bite Wounds
- Dog bite wounds typically contain multiple organisms (average of 5 different bacterial types per wound) 1
- Common pathogens include:
- Pasteurella species (found in approximately 50% of dog bite wounds) 1
- Staphylococcus aureus (found in approximately 40% of bites) 1
- Streptococcus species 1
- Anaerobes including Bacteroides, Fusobacterium, and Porphyromonas species 2
- Capnocytophaga canimorsus (particularly concerning in immunocompromised patients) 1
Alternative Antibiotic Options for Penicillin-Allergic Patients
For Non-Anaphylactic Penicillin Allergy:
- Doxycycline 100 mg orally twice daily (not recommended for children under 8 years) 1
For Severe Penicillin Allergy:
- Fluoroquinolones plus metronidazole for adequate anaerobic coverage 1
Intravenous Options (for severe infections):
- Ampicillin-sulbactam: 1.5-3.0 g every 6-8 hours 2
- Piperacillin-tazobactam: 3.37 g every 6-8 hours 2
- Carbapenems (ertapenem, imipenem, meropenem) 2, 1
Indications for Prophylactic Antibiotic Therapy
Prophylactic antibiotics (3-5 days) are strongly recommended for dog bites in patients with:
- Immunocompromised status or asplenia 1
- Advanced liver disease 1
- Preexisting or resultant edema of the affected area 1
- Moderate to severe injuries, especially to the hand, face, or genitals 1, 3
- Puncture wounds, especially if penetration of bone, tendon sheath, or joint has occurred 1, 3
- Wounds that have undergone primary closure 3
- Presentation more than 9 hours after injury 1
Common Pitfalls to Avoid
- Avoid using first-generation cephalosporins, penicillinase-resistant penicillins, macrolides, or clindamycin alone as they have poor activity against Pasteurella multocida 1
- Delaying treatment for high-risk wounds increases infection risk 1
- Closing puncture wounds or wounds with high risk of infection (except facial wounds) should be avoided 1
- Inadequate irrigation and debridement of wounds can lead to increased infection rates 4, 5
Additional Management Considerations
- Wounds should be thoroughly cleaned and irrigated with sterile normal saline using a 20-mL or larger syringe 4, 5
- Tetanus prophylaxis should be administered if not vaccinated within the past 10 years 1
- Consultation with local health officials regarding rabies post-exposure prophylaxis is recommended 1
- For established infections, cultures should be obtained to guide antibiotic therapy 6
By following these evidence-based dosing recommendations and management principles, clinicians can effectively reduce the risk of infection and improve outcomes in patients with dog bite wounds.