Dog Bite Treatment
Immediately wash the wound thoroughly with soap and water for 15 minutes, then initiate antibiotic prophylaxis with amoxicillin-clavulanate, and provide tetanus and rabies prophylaxis as indicated. 1
Immediate Wound Management
- Irrigate the wound copiously with soap and water for approximately 15 minutes to reduce infection risk and potential rabies transmission 1, 2
- Consider using a virucidal agent such as povidone-iodine solution during irrigation 2
- Carefully examine for deep structure involvement (tendons, bones, joints, ligaments) - pain disproportionate to the visible injury suggests periosteal penetration 1
- Primary closure can be performed after thorough debridement and irrigation, balancing cosmetic considerations against infection risk 1
- Hand wounds and heavily contaminated wounds should generally be left open due to higher infection risk 1
Antibiotic Prophylaxis
Prescribe amoxicillin-clavulanate as first-line prophylactic therapy - this is the Infectious Diseases Society of America's recommended agent 1
High-Risk Wounds Requiring Prophylaxis:
- Hand wounds (particularly over joints, tendons, or bones) 1
- Wounds involving joints, tendons, ligaments, or fractures 1
- Deep puncture wounds 1
- Wounds in immunocompromised patients 1
Alternative Regimens:
- For penicillin-allergic patients: doxycycline OR a fluoroquinolone plus an anaerobic agent (such as metronidazole) 1
- For severe infections requiring IV therapy: β-lactam/β-lactamase combinations, piperacillin-tazobactam, second-generation cephalosporins, or carbapenems 1
Critical Pitfall to Avoid:
Never use first-generation cephalosporins, penicillinase-resistant penicillins, macrolides, or clindamycin alone - these have poor activity against Pasteurella multocida, which is isolated from 50% of dog bite wounds 1
Tetanus Prophylaxis
Rabies Assessment and Prophylaxis
Assess Three Key Factors:
1. Animal Status: 2
- Healthy domestic dog available for 10-day observation: Do not begin prophylaxis unless the animal develops clinical signs of rabies during observation
- Rabid or suspected rabid dog: Immediately begin prophylaxis with both rabies immune globulin and rabies vaccine
- Unknown/escaped dog: Consult local public health officials
2. Circumstances of the Bite: 2
- Unprovoked attacks are more likely to indicate rabies than provoked attacks
- Consult local health department to determine best course based on regional epidemiology
3. Type of Exposure: 2
- Any skin penetration by teeth constitutes a bite exposure requiring evaluation
- Scratches, abrasions, or mucous membrane contamination with saliva also warrant consideration
Rabies Prophylaxis Administration:
- For previously unvaccinated persons: Administer both rabies immune globulin (RIG) and rabies vaccine at different sites 2
- For previously vaccinated persons (with documented titers): Administer vaccine alone 2
- Begin prophylaxis as soon as possible after exposure 2
Monitoring for Complications
Watch for these serious infectious complications: 1
- Septic arthritis
- Osteomyelitis
- Subcutaneous abscess formation
- Tendonitis
- Bacteremia (particularly Capnocytophaga canimorsus in asplenic or hepatic disease patients)
Hand wounds carry significantly higher complication rates than wounds to fleshy body parts and warrant aggressive prophylaxis and close follow-up 1
Microbiologic Considerations
Dog bite wounds are polymicrobial with mixed aerobic and anaerobic bacteria: 1
- Pasteurella species (50% of wounds)
- Staphylococci and streptococci (~40% of wounds)
- Anaerobes including Bacteroides, fusobacteria, Porphyromonas, and peptostreptococci
This polymicrobial nature explains why broad-spectrum coverage with amoxicillin-clavulanate is essential 1