What is the proper treatment for a dog bite?

Proper Treatment for Dog Bite Wounds

The proper treatment for a dog bite includes immediate and thorough wound cleansing with soap and water for 15 minutes, assessment for potential rabies exposure, antibiotic prophylaxis with amoxicillin-clavulanate for high-risk wounds, and tetanus prophylaxis as indicated. 1

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 2
• Consider using a virucidal agent such as povidone-iodine solution for irrigation 3
• Carefully examine the wound for:
  • Tendon, bone, or joint involvement (indicated by pain disproportionate to the injury) 3
  • Foreign bodies or debris that require removal 4
  • Depth of penetration and tissue damage 3
• The decision to suture wounds should take into account:
  • Cosmetic factors (especially for facial wounds) 3, 5
  • Risk of bacterial infection 3
  • Time since injury (wounds >8 hours old generally should not be closed) 3
  • Facial wounds may be an exception and can often be closed primarily after thorough cleaning 3, 5

Antibiotic Prophylaxis

• Preemptive antimicrobial therapy (3-5 days) is recommended for patients who: 3

  • Are immunocompromised
  • Are asplenic
  • Have advanced liver disease
  • Have preexisting or resultant edema of the affected area
  • Have moderate to severe injuries, especially to the hand or face
  • Have injuries that may have penetrated the periosteum or joint capsule

• First-line antibiotic: Amoxicillin-clavulanate (covers both aerobic and anaerobic bacteria) 3, 1

  • For adults: 875/125 mg twice daily 3

• For penicillin-allergic patients, alternatives include: 1

  • Doxycycline (100 mg twice daily)
  • Fluoroquinolone plus an agent active against anaerobes

• For severe infections requiring intravenous therapy: 1

  • β-lactam/β-lactamase combinations
  • Piperacillin-tazobactam
  • Second-generation cephalosporins
  • Carbapenems

Rabies Prophylaxis

• Assess the need for rabies prophylaxis based on: 2

  • Vaccination status of the dog
  • Circumstances of the bite (provoked vs. unprovoked)
  • Whether the animal can be observed for 10 days
  • Local rabies prevalence

• If the dog is healthy and available for 10-day observation: 2

  • Do not begin prophylaxis unless the animal develops clinical signs of rabies
  • Any illness in the animal during confinement should be evaluated by a veterinarian

• If the dog is rabid, suspected rabid, or unknown/escaped: 2

  • Begin rabies prophylaxis immediately
  • Consult public health officials

• Rabies post-exposure prophylaxis consists of: 2

  • Rabies immune globulin (RIG) at presentation
  • Vaccination on days 0,3,7, and 14

Tetanus Prophylaxis

• Administer tetanus prophylaxis based on the patient's immunization status 3, 1
  • For patients with unknown or incomplete tetanus immunization: tetanus toxoid (0.5 mL intramuscularly) 3

Special Considerations

• Hand wounds have higher complication rates and should always receive antibiotic prophylaxis 1

• Children are at higher risk for dog bites, especially to the face, neck, and head 6

• Potential complications to monitor include: 1

  • Septic arthritis
  • Osteomyelitis
  • Subcutaneous abscess formation
  • Tendonitis
  • Bacteremia (rare)

• Common pathogens in dog bite wounds include: 1

  • Pasteurella species (found in 50% of dog bite wounds)
  • Staphylococci and streptococci (found in ~40% of bites)
  • Anaerobes including Bacteroides species, fusobacteria, and Porphyromonas species

Follow-up Care

• Outpatients should be followed up within 24 hours either by phone or during an office visit 3
• If infection progresses despite appropriate antimicrobial therapy, hospitalization should be considered 3
• In most states, physicians are required by law to report animal bites 4