What is the management of animal bite (specifically canine bite) wounds?

From the Guidelines

Dog bite management requires immediate attention to prevent infection and other complications, with a focus on thorough wound cleaning, tetanus prophylaxis, and consideration of antibiotic prophylaxis, particularly in high-risk cases, as recommended by the Infectious Diseases Society of America in 2014 1.

Key Considerations

• Thoroughly clean the wound with soap and water for at least 5 minutes, then apply an antiseptic solution like povidone-iodine, as suggested by the Advisory Committee on Immunization Practices in 2008 1.
• For minor wounds, apply antibiotic ointment (such as bacitracin or mupirocin) and cover with a sterile bandage.
• For deeper or more severe wounds, seek medical attention promptly as these may require professional irrigation, debridement, and possibly suturing.
• Tetanus prophylaxis should be administered if vaccination is not current (within 5 years for dirty wounds or 10 years for clean wounds).
• Antibiotic prophylaxis is often recommended, typically amoxicillin-clavulanate (875/125 mg twice daily for adults or 45 mg/kg/day divided twice daily for children) for 3-5 days, as outlined in the practice guidelines for the diagnosis and management of skin and soft tissue infections by the Infectious Diseases Society of America in 2014 1.

Special Considerations

• High-risk bites (hand, face, genital areas, deep puncture wounds) or bites in immunocompromised individuals require more aggressive treatment.
• Rabies post-exposure prophylaxis should be considered based on the vaccination status of the dog and local rabies prevalence, as recommended by the National Association of State Public Health Veterinarians, Inc. in 2008 1 and 2001 1.
• Watch for signs of infection including increasing pain, redness, swelling, warmth, pus, or fever, which would necessitate immediate medical evaluation.

Bacterial Considerations

• Dog bites are particularly prone to infection due to the bacteria in canine oral flora, including Pasteurella, Streptococcus, Staphylococcus, and anaerobes.
• The choice of antibiotic should consider the potential bacteria involved and local resistance patterns, as discussed in the guidelines for the diagnosis and management of skin and soft tissue infections by the Infectious Diseases Society of America in 2014 1.

From the FDA Drug Label

The likelihood of rabies in a domestic animal varies regionally, and the need for post-exposure prophylaxis also varies on the basis of regional epidemiology. An unprovoked attack might be more likely than a provoked attack to indicate the animal is rabid Bites inflicted on a person attempting to feed or handle an apparently healthy animal should generally be regarded as provoked. Thoroughly wash and flush all bite wounds and scratches immediately or as early as possible (for about 15 minutes, if possible) with soap or a cleansing agent and copious amounts of water. Apply an iodine-containing, or similarly viricidal, topical preparation to the wound Administer Tetanus prophylaxis and measures to control bacterial infection, as indicated. Administer post-exposure antirabies vaccination with rabies vaccine in addition to administering Rabies Immune Globulin (RIG)

Dog Bite Management involves:

• Wound cleaning: Thoroughly wash and flush all bite wounds and scratches immediately with soap and water.
• Wound treatment: Apply an iodine-containing topical preparation to the wound and administer Tetanus prophylaxis and measures to control bacterial infection, as indicated.
• Post-exposure prophylaxis: Administer post-exposure antirabies vaccination with rabies vaccine in addition to administering Rabies Immune Globulin (RIG), considering factors such as the animal's vaccination status, the severity of the bite, and the presence of rabies in the region.
• Consultation: Consult local and state public health officials if questions arise about the need for rabies prophylaxis, especially in cases where the animal's rabies status is unknown or suspected 2.

From the Research

Dog Bite Management

• Dog bites can lead to serious infections and complications if not managed properly 3, 4
• Initiation of prophylactic antibiotics is indicated in certain cases, such as:
  • Primary closure of the wound
  • Moderate or severe bite wounds
  • Puncture wounds, especially if penetration of bone, tendon sheath, or joint occurs
  • Facial bites, bites to the hands or feet, or genital area bites
  • Wounds sustained by victims who are immunocompromised or asplenic 3
• The first-line choice of antibiotic for dog bite management is amoxicillin-clavulanate 3, 4
• Tetanus and rabies prophylaxis should also be considered as part of the treatment plan 3, 4, 5
• Local debridement and thorough cleaning of the wound are essential for proper management 3, 5

Antibiotic Treatment

• Amoxicillin-clavulanic acid is an effective empirical antimicrobial choice for moderate dog bite wounds 6
• The use of enrofloxacin in addition to amoxicillin-clavulanic acid may not be necessary in all cases, and its use should be guided by antimicrobial stewardship principles 6
• Common pathogens associated with dog bite wounds include Staphylococcus pseudintermedius, Neisseria spp., Pasteurella multocida, and P. canis 6

General Principles

• A standardized approach to dog bite management is essential to prevent complications 5
• Basic wound care, including cleansing and irrigation, should be performed as part of the treatment plan 5
• The patient's medical history and the circumstances surrounding the bite should be taken into account when developing a treatment plan 5