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Dog Bite Management: The Evidence

Do dog bites need prophylactic antibiotics?

This is always the big question. Dogs mouths are filthy. The have special bacteria that you have to memorize for board exams (but otherwise are probably meaningless). With all that bacteria, we have to give antibiotics, right? That is certainly how I was taught, but it isn’t clear that that approach is helping our patients.

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 Antibiotics

Augmentin 875/125 mg orally twice daily or 500/125mg three times daily x 7 days OR If penicillin allergic: Adults: moxifloxacin (Avelox) 400mg PO once daily x 7 days OR [Clindamycin 300mg orally every 6 hours PLUSCiprofloxacin 500mg twice daily] Children: [clindamyci

Articles of Interest

Dog Bite Emergency

The bites caused by mammalian teeth are characterized by strong tissue kneading between the jaws, laceration of the skin and deep tooth penetration. The outside of the wound can give an impression of the incoming wound of the tooth, the laceration of the skin, and the avulsion of entire pieces of tissue. Regardless of the external appearance of the wound, it should be kept in mind that the tissue under the skin was exposed to vigorous kneading and cleavage.

Bite injuries: Bark for Dogmentin

Outpatient prophylaxis choices: Amoxicillin/clavulanic acid (i.e. “Dogmentin” as we like to call it) is preferred. If penicillin allergic, doxycycline + clindamycin can be given instead. Duration of therapy is variable, but 3-5 days is more perfect with scheduled wound follow up preferably in 48 hours.

Cat, Dog and Other Bites

As a rule, cat and dog bite wounds should be treated and left open initially. This is true if they are punctures, if the bites are not potentially disfiguring, if they only involve the arms or legs (including the hands or feet) or if the bites to such areas occurred more than 6-12 hours earlier (because the bacteria would be closed into the wound). An exception to the open-wound treatment involves cuts to the face from cat or dog bites. Facial wounds are almost always closed to avoid disfigurement.

Dog bites in the emergency department: a descriptive analysis

The effects of dog bites are wide ranging. They may be as minor as superficial bruising or as serious as life- and limb-threatening injuries. While government data exist on the number and nature of dog bite injuries,10 there is a lack of large, academic studies evaluating the burden of dog bites. There has also been little research describing the interventions required to manage dog bite-related injuries. Of note, prophylactic antibiotics as well as primary v. secondary wound closure, are ongoing controversies, with scant evidence to guide treatment. It is also not known how often dog bites become infected and whether primary closure affects the rate of infection.

Mammalian Bites: ED presentations, evaluation, and management

Augmentin is the oral antibiotic of choice for both prophylaxis and treatment of infected mammalian bites.

Nibbles and Bits: Management of Dog Bite Wounds

At the end of the day, closure decisions for dog bite wounds are much like other decision-making scenarios in medicine. Each case is unique. Each patient has his/her own set of co-morbidities, level of cosmetic concern, and even antibiotic allergies. Each wound has its own age, location, length, and depth. There is no binary “yes” or “no” blanket answer to the question: “Should dog bite wounds be sutured?” But in most cases, after carefully considering all of these factors, the answer for each case is quite apparent.

Resident Clinical Pearl – Animal Bites

Animal bites, like other wounds, require regular wound care with a focus on meticulous cleaning. Cat bites usually need prophylactic antibiotics, dogs usually do not. All immunocompromised hosts get prophylactic antibiotics.

When your best friend bites: A note on dog and cat bites

Most experts currently recommend prophylactic antibiotics for the following situations only: bites with a high risk of infection, such as deep punctures caused by cats; wounds that require surgical repair; attacks involving immunocompromised hosts; and bites involving the hands or face.