Appropriate Management of Pediatric Dog Bites

Dosing Recommendations

For pediatric patients with dog bites, amoxicillin-clavulanate (Augmentin) should be dosed at 45 mg/kg/day divided every 12 hours for moderate to severe injuries, especially those to the hand or face, as recommended by the Infectious Diseases Society of America 1
Children weighing ≥40 kg should follow adult dosing: 875/125 mg twice daily, according to the Infectious Diseases Society of America 1

Preemptive antimicrobial therapy is recommended for pediatric patients with dog bites who have moderate to severe injuries, especially to the hand or face, puncture wounds, immunocompromised status, asplenia, advanced liver disease, preexisting or resultant edema of the affected area, or injuries that may have penetrated the periosteum or joint capsule, as suggested by the Infectious Diseases Society of America 1, 2
Amoxicillin-clavulanate is the first-line treatment because it provides coverage against Pasteurella multocida, Staphylococcus aureus, Streptococcus species, Eikenella corrodens, and anaerobic bacteria, as recommended by the Infectious Diseases Society of America 1, 3

Tetanus toxoid should be administered if the child has not received vaccination within the past 10 years, and Tdap is preferred over Td if the former has not been previously given, according to the Centers for Disease Control and Prevention 1, 4
For patients with penicillin allergy, alternative antibiotics such as cefuroxime or clindamycin plus trimethoprim-sulfamethoxazole or a fluoroquinolone may be used, as suggested by the Infectious Diseases Society of America 1, 3

Evaluate response to treatment within 48-72 hours, and if no improvement or worsening after 72 hours, consider alternative antibiotics or reevaluation, as recommended by the Infectious Diseases Society of America 1, 3

The typical duration of therapy for uncomplicated dog bites is 5-7 days, and may be extended to 10-14 days for more severe infections, especially those involving bones or joints, as recommended by the Infectious Diseases Society of America 5
The American Academy of Pediatrics recommends that children with dog bites receive amoxicillin-clavulanate as first-line treatment due to its coverage against common pathogens, including Pasteurella multocida, Staphylococcus aureus, Streptococcus species, and anaerobic bacteria 5

The Centers for Disease Control and Prevention recommends cleansing dog bite wounds thoroughly with sterile normal saline, removing superficial debris, and evaluating for potential complications such as septic arthritis, osteomyelitis, or tendonitis 5
For children with dog bites, especially those with puncture wounds or bites to high-risk areas, the Infectious Diseases Society of America recommends antibiotic prophylaxis with amoxicillin-clavulanate, and alternative antibiotics such as doxycycline or fluoroquinolones plus metronidazole for penicillin-allergic patients 5

The American Academy of Pediatrics advises against using first-generation cephalosporins, penicillinase-resistant penicillins, macrolides, and clindamycin alone for dog bite treatment due to their poor activity against P. multocida, as recommended by the Infectious Diseases Society of America 5

For asplenic or hyposplenic patients, including those with functional asplenia, the World Health Organization recommends amoxicillin-clavulanate prophylaxis for 5 days due to increased risk of severe sepsis from dog bites 6