From the Guidelines
Antibiotics should be administered to patients with dog bites that are deep, cause significant tissue damage, involve the hands, face, or genitals, or show signs of infection, as well as to immunocompromised patients or those with prosthetic joints. The decision to give prophylactic antibiotics should be based on wound severity and host immune competence 1. According to the practice guidelines for the diagnosis and management of skin and soft tissue infections, amoxicillin-clavulanate is the recommended therapy for animal bites, including dog bites, due to its broad coverage of aerobic and anaerobic bacteria, including Pasteurella multocida, which is commonly found in dog bites 1. Some key points to consider when treating dog bites with antibiotics include:
- The first-line antibiotic is typically amoxicillin-clavulanate (Augmentin) 875/125 mg twice daily for 5-7 days for adults, or 45 mg/kg/day divided into two doses for children.
- Alternative options for penicillin-allergic patients include doxycycline, trimethoprim-sulfamethoxazole plus clindamycin, or a fluoroquinolone plus clindamycin.
- Beyond antibiotics, all dog bites should be thoroughly cleaned with soap and water, and tetanus prophylaxis should be given if vaccination is not current.
- Rabies risk should be assessed, especially with unknown or unvaccinated dogs. It's also important to note that prophylactic or early preemptive therapy seems to provide marginal benefit to wound care for patients with dog bites who present within 12–24 hours after injury, particularly in low-risk wounds 1. However, a meta-analysis of 8 randomized trials of dog bite wounds found a cumulative incidence of infection of 16%, with a relative risk of infection in patients treated with antibiotics compared with controls to be 0.56, suggesting that antibiotics can reduce the risk of infection in dog bite wounds 1. Therefore, the use of antibiotics in dog bites should be guided by the severity of the wound and the patient's immune status, with a focus on preventing infection and promoting healing.
From the Research
Indications for Antibiotic Treatment
- Dog bite wounds may require antibiotic treatment to prevent infection, especially if the wound is deep, large, or has a high risk of contamination 2, 3
- The decision to treat a dog bite with antibiotics depends on various factors, including the severity of the wound, the location of the wound, and the patient's overall health status 3
- Antibiotic treatment is recommended for dog bite wounds that have undergone primary closure, are moderate or severe, or are located on the face, hands, or feet 3
Choice of Antibiotic
- Amoxicillin-clavulanate is a commonly recommended antibiotic for the treatment of dog bite wounds due to its broad-spectrum activity against common pathogens, including Pasteurella multocida and Staphylococcus pseudintermedius 2, 4, 3
- The choice of antibiotic may depend on the specific circumstances of the bite, including the severity of the wound and the patient's medical history 3
- Other antibiotics, such as enrofloxacin, may be used in combination with amoxicillin-clavulanate for more severe infections or in cases where the patient is at high risk of complications 4
Duration of Treatment
- The duration of antibiotic treatment for dog bite wounds is typically 7-10 days, but may vary depending on the severity of the wound and the patient's response to treatment 3
- The treatment should be guided by the patient's clinical response and the results of microbiological tests, if available 4