Management of Dog Bite on Face with Discharge
For a dog bite on the face with discharge, do NOT apply topical antibiotics like bacitracin—instead, focus on systemic oral antibiotics (amoxicillin-clavulanate), thorough wound irrigation with sterile normal saline, and immediate medical evaluation for potential wound debridement and closure. 1, 2, 3
Why Topical Antibiotics Are Not Recommended
- Topical antibiotics like bacitracin are contraindicated for animal bite wounds according to FDA labeling, which explicitly states "do not use" for "animal bites." 4
- Dog bite wounds require systemic antibiotic coverage against the polymicrobial flora (Pasteurella multocida, Staphylococcus aureus, anaerobes) that topical agents cannot adequately address. 1, 5
- The presence of discharge indicates established infection requiring systemic therapy, not superficial topical treatment. 1
Appropriate Systemic Treatment
Antibiotic Therapy
- Amoxicillin-clavulanate 875/125 mg twice daily is the first-line treatment for infected dog bite wounds on the face, providing coverage against both aerobic and anaerobic bacteria. 1, 2, 3
- Treatment duration should be 3-5 days for preemptive therapy, but may require extension to 2-4 weeks if complications like osteomyelitis or septic arthritis develop. 1, 2, 3
- Alternative options for penicillin-allergic patients include:
Wound Care Essentials
- Copious irrigation with sterile normal saline is critical—no need for iodine or antibiotic-containing solutions for irrigation. 1, 3, 6
- Use a 20-mL or larger syringe for irrigation to adequately cleanse the wound, but avoid high-pressure irrigation that may spread bacteria into deeper tissues. 1, 6
- Cautious debridement of devitalized tissue should be performed while preserving as much viable facial tissue as possible for optimal cosmetic outcomes. 1, 3
- The wound should be explored for foreign bodies, tendon injury, or bone involvement, especially if pain is disproportionate to the injury. 1, 6
Special Considerations for Facial Wounds
- Facial dog bite wounds are an exception to the "do not close" rule and should receive primary closure after meticulous wound care due to the rich vascular supply and cosmetic importance. 1, 2, 3
- However, if discharge is already present (indicating infection), the wound should NOT be closed until the infection is controlled. 1
- Delayed primary or secondary closure may be necessary for already infected wounds. 1, 5
Additional Required Interventions
Tetanus Prophylaxis
- Administer tetanus toxoid if vaccination is not current within the past 5-10 years, with Tdap preferred over Td if not previously given. 1, 2, 3
Rabies Assessment
- Consult local health officials to determine if rabies post-exposure prophylaxis is indicated, especially if the dog cannot be confined and observed for 10 days. 2, 3
- If indicated, rabies prophylaxis includes both rabies immunoglobulin and vaccine administered on days 0,3,7, and 14. 2, 6
Elevation and Follow-up
- Elevate the injured area to reduce swelling and accelerate healing, using passive methods like positioning. 1, 3
- Close follow-up within 48-72 hours is mandatory to assess for progression of infection, including increasing pain, redness, swelling, or purulent discharge. 2, 3
Common Pitfalls to Avoid
- Do not rely on topical antibiotics alone—they are inadequate for bite wounds and explicitly contraindicated by FDA labeling. 4
- Do not use first-generation cephalosporins, macrolides, or clindamycin alone—these have poor activity against Pasteurella multocida commonly found in dog bites. 1, 3
- Do not close infected wounds—primary closure should only be performed on clinically uninfected facial wounds after thorough cleaning. 1, 5
- Do not delay seeking medical attention—the presence of discharge indicates infection requiring prompt systemic antibiotic therapy and possible surgical intervention. 1