Dog Bite Management
Dog bite wounds require immediate thorough irrigation with copious sterile normal saline, assessment for deep structure involvement, preemptive antibiotic therapy with amoxicillin-clavulanate for high-risk wounds, tetanus prophylaxis if not current, rabies risk evaluation with local health officials, and mandatory follow-up within 48-72 hours to assess for infection. 1
Immediate Wound Care
Irrigation and Debridement
- Copiously irrigate the wound with sterile normal saline using a 20-mL or larger syringe or 20-gauge catheter attached to the syringe to remove debris and reduce bacterial load 2, 3
- Remove superficial debris and carefully debride devitalized tissue 1, 4
- Explore the wound thoroughly for tendon or bone involvement, joint capsule penetration, and possible foreign bodies 2, 1
Wound Closure Decisions
- Facial wounds should receive primary closure after irrigation, debridement, and preemptive antibiotics for optimal cosmetic results 1, 4
- Non-facial wounds should generally be left open or approximated rather than fully closed due to high infection risk 1
- Heavily contaminated wounds and hand wounds should not be primarily sutured 4
Antibiotic Management
Indications for Preemptive Antibiotics
The Infectious Diseases Society of America recommends 3-5 days of preemptive antimicrobial therapy for: 1
- Immunocompromised patients
- Asplenic patients
- Advanced liver disease
- Edema of the affected area
- Moderate to severe injuries
- Injuries that may have penetrated periosteum or joint capsule
- Cat bites (higher infection risk than dog bites) 2, 5
- Hand wounds 2, 5
Antibiotic Selection
First-line oral therapy: Amoxicillin-clavulanate provides coverage against both aerobic and anaerobic bacteria commonly found in dog bite wounds, including Pasteurella multocida (50% of dog bites), Staphylococcus aureus (40%), Streptococcus species (40%), and anaerobes 1, 6, 2, 3, 5
Alternative oral options: 1, 6
- Doxycycline (excellent activity against Pasteurella multocida)
- Moxifloxacin as monotherapy
- Clindamycin plus a fluoroquinolone
Intravenous options for severe infections or inability to take oral medications: 1, 6
- Ampicillin-sulbactam
- Piperacillin-tazobactam
- Second-generation cephalosporins (cefoxitin)
- Third-generation cephalosporins (ceftriaxone) plus metronidazole
- Carbapenems (ertapenem, imipenem, meropenem)
Treatment Duration
- Uncomplicated infections: 7-10 days total 6
- Septic arthritis: 3-4 weeks 6
- Osteomyelitis: 4-6 weeks 6
- Hand wounds often require longer treatment due to serious nature 6
Critical Pitfall to Avoid
Never use first-generation cephalosporins, macrolides, or penicillinase-resistant penicillins alone due to poor activity against Pasteurella multocida 6
Tetanus Prophylaxis
Administer tetanus toxoid to patients without vaccination within the past 10 years 1, 2
- Prefer Tdap over Td if Tdap has not been previously given 1
Rabies Risk Assessment
Animal Observation Protocol
A healthy dog that bites should be confined and observed daily for 10 days without administering rabies vaccine during the observation period 7
- Evaluate the animal by a veterinarian at first sign of illness 7
- Report any illness immediately to local health department 7
- If signs suggestive of rabies develop, euthanize the animal and ship the head under refrigeration (not frozen) for brain examination 7
Stray or Unavailable Animals
Any stray or unwanted dog that bites may be euthanized immediately and the head submitted for rabies examination 7
Human Rabies Prophylaxis
Consult local health officials to determine if rabies post-exposure prophylaxis should be initiated 1, 6
- If indicated, rabies prophylaxis includes both rabies immunoglobulin at presentation and vaccine on days 0,3,7, and 14 for previously unvaccinated individuals 1, 2
Follow-up Care
All patients must be seen in follow-up within 48-72 hours to assess for signs of infection and evaluate wound healing progress 1
Signs of Infection to Monitor
- Cellulitis
- Abscess formation
- Septic arthritis
- Osteomyelitis
- Bacteremia (rare) 1
Special High-Risk Populations
- Hand wounds require special attention due to higher risk of infection and functional complications 1, 6
- Deep wounds near joints or bones should be evaluated for potential penetration of periosteum or joint capsule 1
- Immunocompromised patients require more aggressive follow-up due to higher infection risk 1
- Asplenic or hepatic disease patients are at particular risk for Capnocytophaga canimorsus infection 6
Non-Infectious Complications to Monitor
- Nerve or tendon injury
- Compartment syndrome
- Post-traumatic arthritis
- Scarring 1