Animal Bite Management

Immediate Wound Care

The American College of Surgeons recommends immediate copious irrigation with sterile normal saline or soap and water, followed by careful debridement of devitalized tissue, as the single most effective measure for preventing both infection and rabies transmission 1
Gentle irrigation technique with a 20-mL or larger syringe should be used, avoiding high-pressure irrigation as it may force bacteria deeper into tissue planes 1
Wounds should be thoroughly explored for tendon or nerve laceration, bone involvement, and foreign bodies 1
Primary closure of most bite wounds should be avoided, as closure increases infection risk, except for facial wounds which should be closed after meticulous irrigation and prophylactic antibiotics for optimal cosmetic results 2, 1
Non-facial wounds may be approximated with Steri-Strips rather than sutured 3

The Infectious Diseases Society of America recommends amoxicillin-clavulanate as the first-line antibiotic for animal bite prophylaxis and treatment, providing essential coverage against Pasteurella multocida, Staphylococcus, Streptococcus, and anaerobes 2, 1
Indications for 3-5 days of prophylactic antibiotics include hand, foot, face, or genital location wounds, deep wounds or puncture wounds, wounds near joints or bones, and immunocompromised, asplenic, or advanced liver disease patients 1, 2
Oral first-line antibiotic regimen is amoxicillin-clavulanate 875/125 mg twice daily 2, 1
Oral alternatives for penicillin allergy include doxycycline 100 mg twice daily or fluoroquinolone plus metronidazole or clindamycin 3, 2, 1

Tetanus toxoid (0.5 mL intramuscularly) should be administered if not vaccinated within the past 5-10 years 3, 1
Tdap is preferred over Td if the patient has not previously received pertussis vaccination 2, 1

A healthy dog or cat that bites should be confined and observed daily for 10 days without administering rabies vaccine during the observation period 4, 2
Rabies post-exposure prophylaxis regimen for previously unvaccinated persons includes both rabies immune globulin and rabies vaccine on days 0, 3, 7, and 14 1
Begin PEP as soon as possible after exposure (within 24 hours), but it remains indicated even with late presentation as incubation periods exceeding 1 year have been documented 2

All patients must be evaluated within 24-72 hours to assess for signs of infection and wound healing progress 3, 2, 1
Hand wounds require particularly close monitoring due to highest infection risk and complication rates 2, 1
Elevate injured extremities to reduce swelling and accelerate healing 3, 1
If infection progresses despite appropriate antimicrobial therapy, hospitalization should be considered 2

Clenched-fist injuries require expert hand evaluation for potential penetration into synovium, joint capsule, or bone, carrying the highest risk of septic arthritis and osteomyelitis 3
Hand wounds have the highest infection risk of all bite locations and may require 4-6 weeks of antibiotics if complications develop 2, 1
Immunocompromised, asplenic, or advanced liver disease patients are at risk for Capnocytophaga canimorsus sepsis from dog bites and require immediate broad-spectrum antibiotics 1

Do not close infected wounds or most non-facial bite wounds primarily 3, 1
Do not administer rabies vaccine to the biting animal during the 10-day observation period 4, 2
Do not use high-pressure irrigation, as it forces bacteria deeper into tissue planes 1