What is the proper treatment for a dog bite?

Dog Bite Treatment

All dog bite wounds require immediate thorough irrigation with soap and water for 15 minutes followed by copious sterile saline irrigation, prophylactic antibiotics with amoxicillin-clavulanate 875/125 mg twice daily for adults (or 25 mg/kg/day divided twice daily for children), tetanus prophylaxis if not current, and rabies risk assessment. 1, 2

Immediate Wound Management

• Irrigate immediately and thoroughly with soap and water for approximately 15 minutes, followed by copious irrigation with sterile normal saline to reduce infection risk and potential rabies transmission 1, 2
• Consider adding povidone-iodine solution to the irrigation as a virucidal agent 1, 3
• Use a 20-mL or larger syringe for adequate cleansing without damaging tissue 2, 4
• Perform only superficial debridement, removing superficial debris but avoiding deep debridement that could enlarge the wound and impair skin closure 5, 1
• Carefully examine for deeper structure involvement including nerve, tendon, bone, or joint penetration—pain disproportionate to injury near a bone or joint suggests periosteal penetration 5, 2

Wound Closure Decision

Facial wounds should receive primary closure after meticulous wound care and irrigation due to excellent blood supply and cosmetic importance, even if presenting beyond 8 hours. 1, 2

• Close facial wounds primarily if seen within 8 hours after thorough irrigation and wound preparation 1
• Primary closure can be performed on facial wounds presenting later than 8 hours if there is thorough wound preparation, copious irrigation, and prophylactic antibiotics are administered 1
• Do not close non-facial wounds, especially hand wounds—these should be approximated with Steri-Strips rather than sutured to reduce infection risk 5, 2
• Infected wounds should never be closed 5

Antibiotic Prophylaxis (Critical)

Amoxicillin-clavulanate is the first-line antibiotic for all dog bites because it provides essential coverage against Pasteurella multocida (present in 50% of dog bites), staphylococci, streptococci, and anaerobes. 5, 1, 2

Dosing:

• Adults: Amoxicillin-clavulanate 875/125 mg twice daily orally 5, 2
• Children: 25 mg/kg/day (of amoxicillin component) divided into 2 doses orally 1
• Duration: 3-5 days for prophylaxis; 4 weeks for septic arthritis; 6 weeks for osteomyelitis 5, 1

High-Risk Wounds Requiring Prophylaxis:

• All facial wounds 1, 2
• Hand or foot wounds 2, 6
• Puncture wounds 6
• Immunocompromised, asplenic, or advanced liver disease patients 2

Penicillin-Allergic Patients:

• Doxycycline (if age ≥8 years) or fluoroquinolone plus metronidazole or clindamycin 1

Critical Pitfall to Avoid:

Never use first-generation cephalosporins (cephalexin), dicloxacillin alone, macrolides (erythromycin), or clindamycin alone—these have poor activity against Pasteurella multocida, the most common pathogen in dog bites. 1

Tetanus Prophylaxis

• Administer tetanus toxoid (0.5 mL intramuscularly) if vaccination is not current within the past 5 years or if status is unknown 5, 1, 2

Rabies Risk Assessment

If the dog is healthy and domestic, confine and observe for 10 days without initiating rabies prophylaxis. 1, 2, 3

• If the dog cannot be observed, is stray, shows concerning behavior, or is a wild/feral animal, initiate rabies post-exposure prophylaxis immediately 1, 2, 3
• Rabies prophylaxis consists of rabies immunoglobulin (administered on day 0 at a different site from vaccine) plus rabies vaccine series on days 0,3,7, and 14 (or day 28 for previously unvaccinated persons) 5, 2, 3
• Consult local health department about regional rabies prevalence and specific recommendations 5, 3

Follow-Up Care

• Schedule follow-up within 24-48 hours to assess for signs of infection including increased pain, erythema, purulent drainage, or fever 1, 2
• Elevate the injured area to reduce swelling 2
• Monitor for complications including cellulitis, abscess formation, wound dehiscence, septic arthritis, or osteomyelitis 5, 1

Common Pitfalls to Avoid

• Do not delay closure of facial wounds due to infection concerns—the face has excellent blood supply and primary closure with antibiotics is standard of care 1, 2
• Do not use inadequate irrigation—copious irrigation is the single most important intervention to prevent infection 1, 2
• Do not prescribe antibiotics with poor Pasteurella coverage (avoid cephalexin, dicloxacillin alone, erythromycin, or clindamycin alone) 1
• Do not forget to document the dog's vaccination status and observability for rabies risk assessment 1, 2
• Do not close hand wounds primarily—these have higher infection rates and should be left open or approximated only 5, 2