What is the proper treatment for a dog bite?

Management of Dog Bite Wounds

Dog bite wounds should be managed with thorough wound cleansing, irrigation, appropriate antibiotic therapy with amoxicillin-clavulanate, tetanus prophylaxis if needed, and consideration of rabies post-exposure prophylaxis based on the circumstances of the bite. 1

Initial Wound Management

• Perform copious irrigation with sterile normal saline using a 20-mL or larger syringe or a 20-gauge catheter to reduce bacterial load and remove debris 1, 2
• Carefully debride devitalized tissue while preserving viable tissue, especially important for facial wounds 1
• Explore the wound for tendon or bone involvement and possible foreign bodies 2

Wound Closure Considerations

• Facial wounds should receive primary closure after thorough cleaning and debridement for optimal cosmetic results due to the rich vascular supply of the face 1, 3
• Non-facial wounds may be approximated rather than fully closed, especially if presenting >8 hours after injury 1, 4
• Hand wounds require special attention due to higher risk of infection and functional complications 1, 5

Antibiotic Therapy

• Amoxicillin-clavulanate (875/125 mg twice daily for adults) is the preferred antibiotic as it provides coverage against both aerobic and anaerobic bacteria commonly found in dog bite wounds 1, 2
• Preemptive antibiotic therapy for 3-5 days is recommended for:
  • Immunocompromised patients
  • Asplenic patients
  • Patients with advanced liver disease
  • Wounds with edema
  • Moderate to severe injuries
  • Injuries that may have penetrated periosteum or joint capsule
  • Hand wounds 1, 4
• Alternative options for penicillin-allergic patients include doxycycline (100 mg twice daily) and fluoroquinolones with additional anaerobic coverage 1, 4
• Prophylactic antibiotics have been shown to reduce infection risk by 44% (relative risk 0.56) in dog bite wounds 6

Tetanus Prophylaxis

• Administer tetanus toxoid to patients without vaccination within the past 10 years 1
• For dirty wounds, tetanus prophylaxis is recommended if vaccination is not current within the past 5 years 1
• Tetanus, diphtheria, and pertussis (Tdap) is preferred over Tetanus and diphtheria (Td) if the former has not been previously given 4

Rabies Prophylaxis

• Consult with local health officials to determine if rabies post-exposure prophylaxis should be initiated 1, 4
• A healthy dog that bites a person should be confined and observed daily for 10 days; rabies vaccine administration is not recommended during this observation period 1
• If rabies prophylaxis is indicated, it should include both rabies immunoglobulin and vaccine for previously unvaccinated individuals 1, 4

Follow-up Care

• All patients should be seen in follow-up within 48-72 hours to assess for signs of infection and evaluate wound healing progress 1, 4
• Monitor for signs of infection, including increasing pain, redness, swelling, or purulent discharge 4
• Extended antibiotic therapy (2-4 weeks) may be necessary if complications such as osteomyelitis or septic arthritis develop 1

Common Pitfalls to Avoid

• Inadequate irrigation and debridement increases infection risk 1
• Delaying primary closure of facial wounds can lead to poorer cosmetic outcomes 1, 3
• Using first-generation cephalosporins, macrolides, or clindamycin alone has poor activity against Pasteurella multocida commonly found in dog bites 1, 7
• Failing to consider rabies prophylaxis for all dog bites, especially from unknown or unvaccinated animals 1
• Overlooking the need for tetanus prophylaxis 1, 8

Special Considerations for High-Risk Wounds

• Dog bites account for 1% of all emergency department visits in the United States 2
• Children are at highest risk for dog bites, particularly to the face due to their height and exploratory behavior 3
• Approximately 16% of untreated dog bite wounds become infected 6
• The bacteriology of dog bite wounds includes mixed aerobic and anaerobic bacteria, with Pasteurella species isolated from 50% of dog bite wounds 7