Augmentin for Dog Bite Treatment
Augmentin (amoxicillin-clavulanate) is the first-line oral antibiotic for dog bite wounds requiring antimicrobial therapy. 1, 2, 3
When to Use Antibiotics for Dog Bites
Not all dog bites require antibiotics. Antibiotic prophylaxis is indicated for:
- Fresh, deep wounds requiring treatment within 24 hours 1
- High-risk anatomical locations: hands, feet, areas near joints, face, and genitals 1, 2
- Patients with elevated infection risk: immunocompromised status, severe comorbidities, or those with implants (artificial heart valves, prosthetic joints) 1
- Wounds with systemic signs of infection or associated severe cellulitis 1
Do not administer antibiotics if the patient presents 24 hours or more after the bite without clinical signs of infection. 1
Recommended Augmentin Dosing
Amoxicillin-clavulanate 875/125 mg twice daily is the standard oral regimen. 3 This combination effectively covers the polymicrobial flora of dog bites, including beta-lactamase-producing organisms. 2, 4
Treatment duration is typically 3 to 5 days for prophylaxis in fresh wounds. 1
Why Augmentin Works for Dog Bites
Dog bite wounds are polymicrobial, averaging 5 bacterial isolates per wound. 5 The key pathogens include:
- Pasteurella species (isolated in ~50% of dog bites) 2, 5
- Staphylococcus and Streptococcus species (~40% of cases) 2
- Capnocytophaga canimorsus (can cause fatal sepsis, especially in asplenic or cirrhotic patients) 1, 2
- Anaerobic bacteria (Fusobacterium, Prevotella, Bacteroides) 1
The clavulanate component specifically addresses beta-lactamase-producing organisms that would otherwise inactivate amoxicillin alone. 2
Alternative Antibiotics for Penicillin Allergy
If the patient has a penicillin allergy:
- Doxycycline 100 mg twice daily is the preferred alternative, with excellent activity against Pasteurella multocida 2, 3
- Fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin) plus metronidazole for anaerobic coverage 1, 2
- Moxifloxacin 400 mg daily as monotherapy covers both aerobes and anaerobes 2
Intravenous Options for Severe Infections
For patients with systemic infection, severe cellulitis, or requiring hospitalization:
- Ampicillin-sulbactam 1, 2
- Piperacillin-tazobactam 1, 2
- Second-generation cephalosporins (cefuroxime, cefoxitin) 1, 2
- Carbapenems (ertapenem, imipenem, meropenem) 1, 2
Antibiotics to AVOID
Do not use the following as monotherapy for dog bites:
- First-generation cephalosporins (cephalexin) - inadequate coverage of Pasteurella and anaerobes 2
- Penicillinase-resistant penicillins (dicloxacillin) - poor Pasteurella coverage 2
- Macrolides (erythromycin) - insufficient spectrum 2
- Clindamycin alone - lacks coverage of key pathogens 2
These agents fail to cover the polymicrobial nature of dog bite infections and should not be used.
Essential Wound Management
Beyond antibiotics, proper wound care is critical:
- Thorough irrigation with copious sterile saline or tap water until all debris is removed - this is the single most important intervention to prevent infection 2, 3
- Avoid high-pressure irrigation as it may drive bacteria deeper into tissues 1
- Do not close infected wounds 2
- Facial wounds may be closed primarily if meticulous wound care, copious irrigation, and prophylactic antibiotics are provided 2
- Debridement of necrotic tissue substantially decreases infection risk 1
Tetanus Prophylaxis
Administer tetanus toxoid if vaccination is not current within the past 10 years. 2, 3 Tdap is preferred over Td if the patient has not previously received it. 3
Complications Requiring Extended Therapy
Watch for serious complications that necessitate prolonged antibiotic courses:
- Osteomyelitis (requires 4-6 weeks of therapy) 2
- Septic arthritis 2
- Subcutaneous abscess formation 2
- Tendinitis 2
- Bacteremia (particularly with Capnocytophaga canimorsus in asplenic patients) 2
Hand wounds are particularly high-risk and often more severe than bites to fleshy body parts. 2 Pain disproportionate to injury severity near a bone or joint suggests periosteal penetration and warrants aggressive evaluation. 2