From the Guidelines
Not all dog bites require antibiotics, but they should be considered in high-risk wounds, such as those that are deep, caused significant tissue damage, or are on the hand, foot, face, or near a joint, as evidenced by a meta-analysis of 8 randomized trials that found a cumulative incidence of infection of 16% 1. When deciding on antibiotic prophylaxis for dog bites, it's crucial to assess the wound severity and the patient's immune competence, as suggested by the Infectious Diseases Society of America's 2014 update on practice guidelines for the diagnosis and management of skin and soft tissue infections 1. Key factors that increase the risk of infection and may necessitate antibiotic use include:
- Puncture wounds
- Wounds in patients with a history of immunocompromising disorders or those using immunosuppressive drugs
- Wounds involving the face, hand, or foot For patients presenting within 12-24 hours after injury with low-risk wounds, prophylactic or early preemptive therapy may provide marginal benefit, but it is generally recommended to limit antibiotics to high-risk wounds 1. Common antibiotics prescribed for dog bites include amoxicillin-clavulanate (Augmentin) 875/125 mg twice daily for 5-7 days, which has been shown to reduce the risk of infection in dog bite wounds, particularly when administered promptly 1. Regardless of whether antibiotics are prescribed, all dog bites should be thoroughly cleaned with soap and water, and medical attention should be sought for proper wound assessment to prevent infections caused by bacteria such as Pasteurella, Staphylococcus, and anaerobes that are commonly found in canine mouths. Additionally, ensuring that tetanus vaccination is up to date and considering rabies prophylaxis if the dog's vaccination status is unknown or if the bite was from a stray dog are important considerations in the management of dog bites.
From the Research
Dog Bites and Antibiotics
- Dog bites can pose significant risks, including infections with potentially life-threatening complications 2
- The use of antibiotics in treating dog bite wounds to reduce the risk of infection is largely supported by the evidence 2
Antibiotic Treatment
- Amoxicillin-clavulanate is often used as empiric therapy for many infectious syndromes, including dog bites 3
- Azithromycin has been shown to be effective in treating certain infections, but its use in dog bites is not well established 4, 5
- The choice of antibiotic and duration of treatment should be based on the severity of the bite and the patient's individual needs 2, 3
Specific Antibiotics
- Amoxicillin-clavulanate has been shown to be effective in treating non-severe respiratory exacerbations in children with bronchiectasis 5
- Clarithromycin has been used to treat group A streptococcal tonsillopharyngitis, but its effectiveness in treating dog bites is not well established 6
- Penicillin V has been used to treat group A streptococcal tonsillopharyngitis, but its use in dog bites is not well established 6
Limitations and Future Research
- Significant limitations exist in the research on antibiotic treatment for dog bites, including patient-specific criteria for administering prophylactic antibiotics and the associated risks and financial costs 2
- Further research into antibiotic treatment for dog bites would help to support clinicians and inform safe practice 2