From the Guidelines
Dog bite management requires immediate attention to prevent infection and other complications, with a focus on thorough wound cleansing and consideration of antibiotic prophylaxis for high-risk wounds, as recommended by the Infectious Diseases Society of America in 2014 1. The management of dog bites involves several key steps to prevent infection and promote healing. First, the wound should be cleaned thoroughly with soap and water for at least 5 minutes, then an antiseptic solution like povidone-iodine should be applied, as suggested by the Advisory Committee on Immunization Practices in 2008 1.
- For minor wounds, applying antibiotic ointment and covering with a sterile bandage may be sufficient.
- For deeper or more severe wounds, seeking medical attention promptly is crucial as they may require professional cleaning, debridement, or suturing.
- Tetanus prophylaxis should be administered if the patient's vaccination is not up to date (Td or Tdap).
- Antibiotic prophylaxis is recommended for high-risk wounds (deep punctures, hand/foot/face wounds, or immunocompromised patients), typically with amoxicillin-clavulanate 875/125 mg twice daily 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.
- For penicillin-allergic patients, doxycycline 100 mg twice daily or clindamycin 300 mg four times daily plus ciprofloxacin 500 mg twice daily can be used.
- Rabies post-exposure prophylaxis should be considered based on the vaccination status of the dog and local rabies prevalence, including rabies immune globulin at the wound site and a series of rabies vaccines on days 0,3,7, and 14.
- Monitoring the wound for signs of infection, including increasing pain, redness, swelling, warmth, pus, or fever, is essential, and any signs of infection should prompt immediate medical attention. The bacteriology of dog bite wounds can be complex, involving various pathogens such as Pasteurella, Staphylococcus, and anaerobes, making appropriate antibiotic selection critical, as discussed in the guidelines 1.
From the Research
Dog Bite Management
- Dog bites can lead to serious infections, especially in medically compromised individuals, and require aggressive management 2
- The use of copious irrigation and debridement is more effective in preventing infection than the use of prophylactic antibiotics 2
- Tetanus prophylaxis should be considered for every bite wound, while rabies prophylaxis is warranted in selected cases 2, 3
Treatment and Care
- Thorough debridement and immediate primary wound closure can be effective in treating animal bite injuries of the upper limbs 4
- Debridement to achieve wound closure is indispensable in patients with animal bite injuries of the upper limbs 4
- Antibiotic prophylaxis may be indicated in certain cases, such as human bites or non-human bites with a high risk of infection 5, 6
Prevention of Complications
- Mixed aerobe and anaerobe infection is the most common type of infection in mammalian bites, and can occur in up to half of human bites 5
- A systematic approach to care, including eliciting a history of the circumstances surrounding the bite and the patient's medical history, is important in preventing complications 6
- Basic bite wound care, including cleansing and irrigation of the wound, is essential in preventing infection 6