What is the recommended treatment for dog bite cases?

Dog Bite Treatment

Immediately wash all dog bite wounds with soap and water for 15 minutes, then initiate amoxicillin-clavulanate prophylaxis, particularly for hand wounds, wounds over joints/tendons/bones, and in immunocompromised patients. 1, 2

Initial Wound Management

Thorough irrigation is the cornerstone of preventing infection:

• Wash and flush all bite wounds with soap and water for approximately 15 minutes to reduce infection risk and potential rabies transmission 1, 2
• Consider using povidone-iodine solution for additional virucidal effect 3
• Carefully examine for tendon, bone, or joint involvement—pain disproportionate to the injury near a bone or joint suggests periosteal penetration 1, 2
• Remove any foreign bodies and devitalized tissue during wound exploration 4
• Assess neurovascular function including pulses, sensation, and range of motion of adjacent joints 4

Wound closure decisions:

• Facial wounds may be closed primarily if seen early and properly cleaned for cosmetic reasons 1, 2
• Low-risk wounds may undergo primary closure 4
• Avoid suturing heavily contaminated wounds or hand wounds 5
• Consider delayed closure for high-risk or already infected wounds 6

Antibiotic Prophylaxis

Amoxicillin-clavulanate is the first-line prophylactic antibiotic for all dog bite wounds as recommended by the Infectious Diseases Society of America 1, 2, 4

High-risk wounds requiring prophylaxis include:

• Hand wounds (particularly over joints, tendons, or bones) 1, 2, 3
• Wounds involving joints, tendons, ligaments, or fractures 2
• Immunocompromised patients 1, 3
• Puncture wounds 7

Alternative regimens for penicillin-allergic patients:

• Doxycycline 1, 2
• Fluoroquinolone plus an agent active against anaerobes 1, 2
• Clindamycin plus a fluoroquinolone 1

Avoid these antibiotics due to poor activity against Pasteurella multocida:

• First-generation cephalosporins 2, 3
• Penicillinase-resistant penicillins 2, 3
• Macrolides 2, 3
• Clindamycin alone 2, 3

For severe infections requiring IV therapy:

• β-lactam/β-lactamase combinations 2, 3
• Piperacillin-tazobactam 2, 3
• Second-generation cephalosporins 2, 3
• Carbapenems 2, 3

The evidence supporting prophylactic antibiotics is solid—meta-analysis shows a relative risk reduction to 0.56, with approximately 14 patients needing treatment to prevent one infection 8

Rabies Prophylaxis

Assessment criteria for rabies risk:

• Vaccination status of the dog 1, 9
• Circumstances of the bite (unprovoked attacks are higher risk) 9
• Whether the dog can be observed for 10 days 1, 9
• Regional rabies epidemiology 9

If rabies prophylaxis is indicated:

• Administer both rabies immune globulin (RIG) and rabies vaccine 1, 3
• Give the first vaccine dose as soon as possible after exposure 1, 3
• Vaccination schedule: days 0,3,7, and 14 7
• For previously vaccinated persons with documented titers, administer vaccine alone without RIG 9

Observation protocol for healthy domestic dogs:

• Do not begin prophylaxis unless the animal develops clinical signs of rabies during the 10-day observation period 9
• If the animal exhibits clinical signs, it should be euthanized immediately and tested 9

Tetanus Prophylaxis

Assess tetanus immunization status and administer prophylaxis as indicated 1, 2, 3, 9

• Give tetanus toxoid to patients with unknown or incomplete tetanus immunization 1

Microbiology and Complications to Monitor

Dog bite wounds are typically polymicrobial with mixed aerobic and anaerobic bacteria: 2

• Pasteurella species (isolated from 50% of dog bite wounds) 2, 6
• Staphylococci and streptococci (found in ~40% of bites) 2, 6
• Anaerobes including Bacteroides species, fusobacteria, Porphyromonas species, and peptostreptococci 2, 6
• Capnocytophaga canimorsus can cause bacteremia and fatal sepsis, especially in patients with asplenia or underlying hepatic disease 1, 2, 3

Infectious complications to monitor:

• Septic arthritis 1, 2
• Osteomyelitis 1, 2
• Subcutaneous abscess formation 1, 2
• Tendonitis 1, 2
• Bacteremia 1, 2

Common pitfall: Hand wounds often have more serious complications than wounds to fleshy parts of the body and should never be underestimated 2

Imaging and Laboratory Studies

Generally not required unless:

• Suspicion of retained foreign body 4
• Damage to underlying structures 4
• Signs of infection 4
• Extensive injury 4