From the Guidelines
For a deep dog bite wound to the knee, the recommended antibiotic is typically amoxicillin-clavulanate (Augmentin) 875/125 mg taken orally twice daily for 5-7 days. This antibiotic combination is effective against the mixed bacterial flora found in dog bites, including Pasteurella, Streptococcus, Staphylococcus, and anaerobes, as recommended by the Infectious Diseases Society of America 1. The choice of amoxicillin-clavulanate is based on its broad-spectrum activity and the fact that it is one of the recommended therapies for animal bites, as outlined in Table 5 of the guidelines 1.
For those with penicillin allergies, alternatives include doxycycline 100 mg twice daily, or a combination of clindamycin plus either trimethoprim-sulfamethoxazole or a fluoroquinolone, as suggested by the guidelines 1. It's also important to note that the bacteriology of dog bite wounds can be complex and may involve multiple isolates per wound, which may require additional coverage for anaerobes 1.
Beyond antibiotics, the wound requires:
- Thorough cleaning with soap and water
- Irrigation with sterile saline
- Possibly debridement of devitalized tissue Tetanus prophylaxis should be updated if needed. Due to the deep nature of the wound, medical attention should be sought immediately as it may require professional wound care, possible surgical exploration, and evaluation for damage to underlying structures like tendons, ligaments, or joints. Dog bites carry a high risk of infection due to the bacteria in canine mouths and the crushing, tearing nature of the wounds, which is why prompt treatment with appropriate antibiotics is essential, as supported by the guidelines 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Dog Bite Wound Treatment
- Dog bites can result in knee-deep wounds that require immediate medical attention to prevent infection and promote healing.
- The most prevalent organisms found in infected dog bite wounds are Pasteurella, streptococci, staphylococci, and Fusobacterium, Bacteroides, and Porphyromonas species 2.
- Treatment includes thorough cleansing of the wound, with copious irrigation, and suitable antibiotics for the initial empiric and expectant therapy.
Antibiotic Treatment
- Amoxicillin-potassium clavulanate is a commonly recommended antibiotic for the treatment of dog bite wounds, especially for patients who are not allergic to penicillins 2, 3.
- A penicillin with a first-generation cephalosporin, or clindamycin and a fluoroquinolone, may also be used as alternative antibiotic treatments 2.
- Amoxicillin-clavulanic acid is an appropriate empirical antimicrobial choice for moderate dog bite wounds, with over 90% of gram-negative and gram-positive isolates susceptible to this antibiotic 4.
Wound Care and Prevention
- Bite wounds should be cleaned, copiously irrigated with normal saline, and explored for tendon or bone involvement and possible foreign bodies 3.
- Antibiotic prophylaxis should be considered, especially if there is a high risk of infection, such as with cat bites, puncture wounds, wounds to the hand, and in persons who are immunosuppressed 3.
- Preventive strategies should be aimed at public awareness of basic animal safety and responsible pet ownership 2.