Dog Bite to the Hand: Treatment Recommendations
For dog bites to the hand, immediately initiate amoxicillin-clavulanate 875/125 mg twice daily as first-line antibiotic therapy, as hand wounds carry significantly higher infection risk and worse outcomes than bites to other body locations. 1
Why Hand Bites Require Aggressive Treatment
Hand wounds from dog bites are particularly serious and demand more aggressive management than bites to other anatomical locations 2, 1. The hand's numerous small compartments and thin soft tissue covering over bones and joints make infection substantially more likely 3. Patients with hand injuries face a 2-fold increased risk of secondary infectious presentations (OR 2.08,95% CI 1.21-3.55) 4. These complications often manifest as septic arthritis, osteomyelitis, tendonitis, and subcutaneous abscesses 2.
Immediate Antibiotic Selection
Amoxicillin-clavulanate is the preferred oral agent providing comprehensive coverage against the polymicrobial flora typical of dog bites 2, 1. Dog bite wounds contain an average of 5 different bacterial species, including:
- Pasteurella species (50% of dog bites) 2, 1
- Staphylococcus aureus (40% of cases) 1
- Streptococcus species (40% of cases) 1
- Anaerobes including Bacteroides, Fusobacterium, Porphyromonas, and Prevotella 2, 1
Alternative Oral Options if Amoxicillin-Clavulanate is Contraindicated:
- Doxycycline (excellent activity against Pasteurella multocida) 1
- Moxifloxacin as monotherapy 1
- Clindamycin plus a fluoroquinolone 1
Intravenous Options for Severe Infections:
- Piperacillin-tazobactam 2, 1
- Ampicillin-sulbactam 2
- Carbapenems (ertapenem, imipenem, meropenem) 2, 1
- Second-generation cephalosporins (cefoxitin) 2, 1
- Third-generation cephalosporins (ceftriaxone) plus metronidazole 1
Treatment Duration Algorithm
For uncomplicated hand infections: 7-10 days total 1
For complications:
Initial IV therapy duration: 3-5 days for patients with systemic symptoms, moderate to severe infections, or high-risk wounds 1. Transition to oral therapy when the patient is afebrile and local signs improve 1.
Essential Wound Management
- Thoroughly cleanse with sterile normal saline and remove superficial debris 1
- Debride necrotic tissue and explore for foreign bodies 1
- Assess for tendon, bone, or joint involvement 1
- Elevate the injured hand, especially if swollen, to accelerate healing 2
Critical caveat: Pain disproportionate to injury severity near a bone or joint suggests periosteal penetration, requiring more aggressive management 2, 1.
Additional Prophylaxis Requirements
Tetanus prophylaxis: Administer if vaccination not current within 10 years (Tdap preferred over Td if not previously given) 1
Rabies prophylaxis: Consult local health officials to determine need for postexposure prophylaxis (immune globulin plus vaccination on days 0,3,7, and 14) 1
Critical Pitfalls to Avoid
Never use these antibiotics alone for dog bite hand wounds:
- First-generation cephalosporins (e.g., cephalexin) 2, 1
- Macrolides (e.g., erythromycin) 2, 1
- Penicillinase-resistant penicillins (e.g., dicloxacillin) 2, 1
These agents have poor activity against Pasteurella multocida, present in 50% of dog bites 2, 1.
Special High-Risk Considerations
Be vigilant for Capnocytophaga canimorsus in patients with:
This organism can cause fatal sepsis and multiorgan failure even from seemingly minor bites 5. These patients may require more aggressive initial IV therapy 1.
Other high-risk patient factors requiring aggressive management: