What is the management approach for dog bite admissions?

Management of Dog Bite Admissions

The management of dog bite admissions requires immediate wound cleansing with soap and water, assessment for rabies risk, observation of the biting dog for 10 days, and consideration of antibiotic prophylaxis, especially for high-risk wounds such as hand injuries. 1

Initial Wound Management

• Thorough washing and flushing (for about 15 minutes if possible) with soap or cleansing agent and copious amounts of water should be done immediately for all bite wounds and scratches 1
• Apply an iodine-containing or similarly virucidal topical preparation to the wound where available 1
• Evaluate the wound for tendon or bone involvement and possible foreign bodies 2
• Consider wound closure if cosmetically favorable (such as wounds on the face) or if wounds are gaping 2

Rabies Risk Assessment and Management

For the Biting Dog:

• A healthy dog that bites a person should be confined and observed daily for 10 days 3
• Rabies vaccination should not be administered to the dog during the observation period 3
• If signs suggestive of rabies develop in the dog, it should be euthanized immediately, its head removed, and submitted for rabies examination 3
• Any stray or unwanted dog that bites a person may be euthanized immediately and the head submitted for rabies examination 3

For the Bite Victim:

• Post-exposure rabies prophylaxis should not begin unless the dog develops clinical signs of rabies during the 10-day observation period 1
• If the dog is rabid or suspected rabid, immediately begin rabies prophylaxis 1
• If the dog's status is unknown (e.g., escaped), consult public health officials 1
• For previously unvaccinated persons exposed to a rabid animal, both human rabies immune globulin (RIG) and vaccine should be administered 1

Antibiotic Prophylaxis

• Consider antibiotic prophylaxis, especially for high-risk wounds 2:
  • Puncture wounds
  • Hand injuries
  • Facial injuries
  • Immunocompromised patients
  • Wounds with established infection
• Amoxicillin-clavulanate is the first-line prophylactic antibiotic (875/125 mg twice daily for 3-5 days) 4, 2
• For patients with penicillin allergy, alternatives include doxycycline or clindamycin plus a fluoroquinolone 4

Special Considerations for High-Risk Patients

• Elderly patients have increased risk of infection complications from animal bites 4
• Dog bites become infected in approximately 5-25% of cases, with higher risk in elderly patients 4
• Injuries to the hand are at increased risk for secondary presentations due to infection (OR 2.08,95% CI 1.21-3.55) 5
• Children are especially vulnerable to injuries in the craniofacial region due to their height and behavior 6, 7

Documentation and Reporting

• Document the dog bite injury with photographs and diagrams when appropriate 8
• In most states, physicians are required by law to report animal bites to local health authorities 2

Common Pitfalls to Avoid

• Do not rely solely on the dog's vaccination status - this protects against rabies but not bacterial infection 4
• Do not delay antibiotic therapy in high-risk patients (elderly, immunocompromised) 4
• Avoid suturing heavily contaminated wounds or wounds on the hand, as this may increase infection risk 4, 7
• Do not use antibiotics with insufficient anaerobic coverage for dog bite wounds 4