Management of Dog Bite Wounds

Initial Management

Dog bites should be cleaned immediately with copious irrigation using water or normal saline solution to significantly decrease the risk of bacterial infection 1

Facial wounds can be closed primarily after copious irrigation, careful debridement, and administration of preventive antibiotics 1

Primary closure of dog bite wounds in areas other than the face is generally not recommended 1
For non-facial wounds, consider approximating edges without complete closure 1
For non-facial wounds, especially hand wounds, consider leaving wounds open due to a higher risk of infection if closed 1

Early preventive antimicrobial therapy (3-5 days) is recommended for immunocompromised patients, asplenic patients, patients with advanced liver disease, wounds with pre-existing or resulting edema, and moderate to severe lesions, especially on the hand or face 1
Amoxicillin-clavulanate is the first-line prophylactic antibiotic as it is active against both aerobic and anaerobic bacteria commonly found in dog bite wounds 1

Tetanus prophylaxis should be administered to patients who have not been vaccinated in the last 10 years (or 5 years for dirty wounds) 1
The Tdap vaccine is preferred over the Td vaccine if the former has not been previously administered 1
Rabies prophylaxis may be necessary - consult local health authorities to determine if vaccination should be initiated 1
A healthy dog that bites a person should be confined and observed daily for 10 days; any illness should be reported immediately to the local health department 2, 3

Hand wounds have a particularly high risk of infection and should generally not be sutured 1