What is the treatment for a dog bite with no open wound?

Dog Bite Without Open Wound: Treatment Approach

For a dog bite with no open wound (no break in skin integrity), rabies postexposure prophylaxis is not indicated, and antibiotic prophylaxis is generally not necessary unless the patient is severely immunocompromised. 1, 2

Immediate Wound Assessment and Care

• Thoroughly examine the bite site for any breaks in skin integrity, including microscopic abrasions, punctures, or disruption of the epidermal barrier that may not be immediately visible 2
• Wash the area thoroughly with soap and copious amounts of water for approximately 15 minutes, even without visible skin break 1, 3
• Document the exact location, appearance, and any bruising or tissue damage from crush injury 4

Rabies Risk Management

• Intact skin exposure to dog saliva does not warrant rabies postexposure prophylaxis, even if the dog's rabies status is unknown 2
• If the skin is definitively intact with no visible breaks, rabies PEP is not indicated 2
• If there is ANY doubt about skin integrity, treat as a potential rabies exposure: confine and observe a healthy domestic dog for 10 days without initiating prophylaxis unless the dog develops signs of rabies 1, 2, 5
• Consult local health officials to determine regional rabies risk and observation protocols 1

Antibiotic Considerations

• Prophylactic antibiotics are NOT routinely indicated for dog bites without skin penetration 1, 2

• Consider antibiotics only in the following high-risk scenarios even without obvious wound:

  • Severely immunocompromised patients (concern for microscopic breaks) 2
  • Asplenic patients 1, 2
  • Advanced liver disease 1, 2
  • Significant edema or crush injury to the affected area 1

• If antibiotics are indicated, amoxicillin-clavulanate 875/125 mg twice daily for 3-5 days is the first-line choice 1, 2, 6

Tetanus Prophylaxis

• Administer tetanus toxoid if the patient has not been vaccinated within the past 10 years, with Tdap preferred over Td if not previously given 2, 6
• This applies even without an open wound if there is any tissue trauma 1, 3

Follow-up Protocol

• Schedule follow-up within 48-72 hours to reassess for delayed signs of infection or tissue damage 2, 6
• Instruct the patient to return immediately if signs of infection develop (increasing pain, redness, swelling, warmth, purulent drainage, fever) 2
• Monitor for development of bruising or delayed skin breakdown that may indicate deeper tissue injury 4

Critical Pitfalls to Avoid

• Do not dismiss crush injuries without skin break - significant underlying soft tissue damage, nerve injury, or vascular compromise can occur even with intact skin 4
• Carefully inspect for puncture wounds that may appear as tiny marks but represent full-thickness skin penetration requiring different management 1, 4
• Do not start rabies prophylaxis prematurely if a healthy domestic dog can be observed - wait for signs of illness during the 10-day observation period 1, 2, 5