What is the recommended management approach for a dog bite in a specific location, considering local epidemiology of rabies?

Dog Bite Management

A healthy dog that bites a person should be confined and observed for 10 days without administering rabies vaccine during this period, while the wound is immediately irrigated with soap and water for at least 15 minutes, followed by antibiotic prophylaxis with amoxicillin-clavulanate for most bites. 1, 2, 3

Immediate Wound Care

• Irrigate the wound thoroughly with soap and copious amounts of water for at least 15 minutes to reduce rabies transmission risk and bacterial load 2, 4, 3
• Remove any foreign bodies and debride devitalized tissue 5, 3
• Examine and document neurovascular function (pulses, sensation) and range of movement of adjacent joints 3
• Document the injury with photographs and diagrams when appropriate 4

Management of the Biting Animal

For Owned/Known Dogs, Cats, or Ferrets:

• Confine the healthy animal and observe daily for 10 days 1
• Do not administer rabies vaccine to the animal during the observation period 1
• Have a veterinarian evaluate the animal at the first sign of illness during confinement 1
• Report any illness immediately to the local health department 1
• If signs suggestive of rabies develop, euthanize the animal, remove the head, and ship under refrigeration (not frozen) for brain examination by a qualified laboratory 1

For Stray or Unwanted Dogs, Cats, or Ferrets:

• May be euthanized immediately and the head submitted for rabies examination 1
• This approach is preferred when the animal cannot be reliably confined or observed 1

For Wild Mammals or Other Animals:

• Report immediately to the local health department 1
• Wild mammals that bite should be considered for euthanasia and rabies examination 1
• Management depends on the species, circumstances of the bite, local rabies epidemiology, and the animal's history and health status 1

Rabies Post-Exposure Prophylaxis for the Victim

If Animal is Confirmed or Suspected Rabid, High-Risk, or Unavailable:

• Administer both human rabies immune globulin (HRIG) at 20 IU/kg body weight and rabies vaccine simultaneously on day 0 at different anatomical sites 2
• Infiltrate the full HRIG dose around and into the wound if anatomically feasible, with any remaining volume injected intramuscularly at a distant site from the vaccine 2
• Administer a 5-dose series of rabies vaccine over 28 days: days 0,3,7,14, and 28 2
• Do not delay prophylaxis waiting for animal testing results 2
• Never administer HRIG after day 7 of the vaccine series 2

If Animal is Available for 10-Day Observation:

• Rabies prophylaxis can typically be deferred while awaiting the observation period results 1
• Initiate prophylaxis immediately if the animal develops signs of rabies during observation 1

Antibiotic Prophylaxis

• Amoxicillin-clavulanate is the first-line antibiotic choice for prophylaxis and should be considered for all bites, particularly those at increased risk of infection 5, 3
• Alternative options include moxifloxacin, which offers excellent in vitro coverage of pathogenic flora from dog bites 5
• High-risk wounds include hand bites, puncture wounds (especially from cats), wounds with delayed presentation (>8-12 hours), and wounds requiring closure 6, 5, 3
• Common pathogens include Pasteurella multocida, Staphylococcus aureus, viridans streptococci, Capnocytophaga canimorsus, and oral anaerobes 5

Wound Closure Decisions

• Primary surgical repair is the treatment of choice for most clinically uninfected facial bite wounds 5, 7
• Wounds may be sutured after debridement and thorough irrigation, unless they are located on the hand, where infection is common 6, 7
• Delayed closure should be reserved for high-risk or already infected wounds 5
• Heavily contaminated wounds should not be immediately sutured 7

Tetanus Prophylaxis

• Assess tetanus immunization status and administer a booster if indicated 2, 4, 3
• This is essential in the management of all dog bites 4, 3

Reporting Requirements

• Report the incident immediately to the local health department 1, 2
• This is mandatory for proper public health surveillance and rabies control 1

Common Pitfalls to Avoid

• Never delay rabies prophylaxis waiting for animal testing if the animal is confirmed rabid, high-risk, or unavailable for observation 2
• Do not administer HRIG after day 7 of the vaccine series, as it may interfere with vaccine-induced immunity 2
• Do not primarily close hand wounds due to high infection risk 6, 7
• Do not neglect tetanus status assessment 2, 4, 3
• Children most often present with head and neck bites, while adults typically have extremity bites—adjust examination focus accordingly 3