Dog Bite Management: Additional Considerations
Your management is excellent and comprehensive, but you should extend the Augmentin duration to 7 days minimum, consider rabies post-exposure prophylaxis consultation, ensure close follow-up instructions for infection monitoring, and verify the hand wound doesn't involve deeper structures.
Antibiotic Duration
The current 5-day Augmentin course should be extended to 7 days for optimal outcomes. While the Infectious Diseases Society of America recommends 3-5 days for standard bite wounds 1, the presence of both a complex scalp laceration with suturing and a hand puncture wound warrants the longer duration given the hand's high infection risk and the scalp wound's complexity.
Amoxicillin-clavulanate remains the correct first-line choice, providing coverage against Pasteurella multocida, Staphylococcus, Streptococcus, and anaerobes commonly found in dog bite wounds 2, 1.
Rabies Assessment
You must consult with local health officials regarding rabies post-exposure prophylaxis, even though the dog is known. The FDA guidelines explicitly recommend this consultation for all dog bite exposures 3.
Key factors for rabies risk assessment include: the dog's vaccination status, ability to observe the dog for 10 days, and local rabies epidemiology 3.
If the dog cannot be observed or shows any signs of illness, rabies post-exposure prophylaxis should be initiated immediately with both rabies immune globulin and vaccine 3.
Hand Wound Specific Concerns
The hand puncture requires particularly vigilant monitoring due to the high risk of deep structure involvement (tendons, joints, bone). Hand bites have elevated infection rates and can lead to serious complications including septic arthritis and osteomyelitis 2.
Ensure the patient can fully flex and extend all fingers, has intact sensation, and has no joint tenderness—any concern warrants immediate hand surgery consultation 2.
The decision to leave the hand puncture open is correct, as primary closure of puncture wounds increases infection risk 1.
Wound Care Instructions
Your instruction to avoid washing hair for 48 hours is appropriate, but add specific signs of infection to monitor: increasing redness beyond 1-2 cm from wound edges, purulent drainage, fever >38°C, or increasing pain after initial 48 hours 2.
For the hand wound, instruct elevation above heart level for the first 48-72 hours to minimize edema, which can compromise perfusion and increase infection risk 2.
Follow-up Timing
Consider earlier follow-up at 48-72 hours for wound check, particularly for the hand puncture. This allows early detection of infection, which develops in approximately 15-20% of dog bite wounds despite prophylactic antibiotics 1.
The 7-day suture removal timing for the scalp is appropriate 2.
Documentation and Reporting
- Confirm that the police report includes the dog owner's contact information and the dog's rabies vaccination status—this is essential for the 10-day observation period if rabies prophylaxis is deferred 3.
Additional Safety Considerations
Verify tetanus status was truly up to date (within 10 years for clean wounds, within 5 years for contaminated wounds). If the last dose was >5 years ago, Tdap is preferred over Td if not previously given 1, 3.
Warn the patient that despite antibiotics, infection can still develop and requires immediate return if any concerning signs appear 1.