What is the management for a dog bite in a 12-year-old girl?

Management of Dog Bite in a 12-Year-Old Girl

The management of a dog bite in a 12-year-old girl should include immediate thorough wound cleansing with soap and water, appropriate antibiotic prophylaxis with amoxicillin-clavulanate, tetanus prophylaxis if needed, and assessment for rabies risk with observation of the dog for 10 days. 1, 2

Initial Wound Management

• Immediate and thorough washing of all bite wounds with soap and water is the most effective measure for preventing rabies and bacterial infections 2
• Copious irrigation with normal saline using a 20-mL or larger syringe or a 20-gauge catheter should be performed to clean the wound 3
• The wound should be explored for tendon or bone involvement and possible foreign bodies 3
• For facial wounds, primary closure is recommended after thorough cleansing for optimal cosmetic results 1, 4
• Non-facial wounds may be approximated rather than fully closed to reduce infection risk 1

Antibiotic Prophylaxis

• Amoxicillin-clavulanate is the preferred antibiotic as it provides coverage against both aerobic and anaerobic bacteria commonly found in dog bite wounds, including Pasteurella species 1, 5
• A 3-5 day course of antibiotics is recommended, especially for moderate to severe injuries or if the wound is on the hand or face 1
• Alternative options for penicillin-allergic patients include doxycycline or fluoroquinolones with anaerobic coverage 1

Tetanus Prophylaxis

• Tetanus toxoid should be administered if the child has not been vaccinated within the past 10 years 1, 3
• Tetanus, diphtheria, and pertussis (Tdap) is preferred over Tetanus and diphtheria (Td) if the former has not been previously given 1

Rabies Risk Assessment and Management

• The biting dog should be confined and observed daily for 10 days; administration of rabies vaccine to the dog is not recommended during the observation period 6
• If the dog is healthy and available for 10-day observation, no rabies prophylaxis is needed for the child unless the animal develops signs of rabies 2
• If the dog is rabid, suspected rabid, or unknown (escaped), consultation with local public health officials is recommended to determine the need for rabies prophylaxis 2
• If rabies prophylaxis is indicated, it should include both rabies immunoglobulin and vaccine 1, 2

Follow-up Care

• The child should be seen in follow-up within 48-72 hours to assess for signs of infection and evaluate wound healing 1
• Any illness in the dog during the observation period should be reported immediately to the local health department 6
• If signs suggestive of rabies develop in the dog, it should be euthanized and tested for rabies 6

Special Considerations

• Hand wounds require special attention due to higher risk of infection and functional complications 1
• Deep wounds near joints or bones should be evaluated for potential penetration of periosteum or joint capsule 1
• In most states, physicians are required by law to report animal bites to local health authorities 3

Potential Complications

• Infectious complications include cellulitis, abscess formation, septic arthritis, osteomyelitis, and rarely bacteremia 1
• Non-infectious complications include nerve or tendon injury, compartment syndrome, post-traumatic arthritis, and scarring 1
• Children are especially vulnerable to injuries in the craniofacial region due to their height and behavior patterns 4