Dog Bite Treatment Guidelines

Initial Wound Management

The Centers for Disease Control and Prevention recommends immediate and thorough wound cleansing with soap and water, assessment for potential rabies exposure, antibiotic prophylaxis with amoxicillin-clavulanate, and tetanus prophylaxis as indicated 1, 2
Immediately wash and flush all bite wounds thoroughly with soap and water for about 15 minutes to reduce the likelihood of infection and rabies transmission 1
The decision to suture large wounds should take into account cosmetic factors and the potential for bacterial infection 1

The Infectious Diseases Society of America recommends amoxicillin-clavulanate as the first-line prophylactic antibiotic for dog bite wounds 2
Alternative oral agents for penicillin-allergic patients include doxycycline or a fluoroquinolone plus an agent active against anaerobes 2
First-generation cephalosporins, penicillinase-resistant penicillins, macrolides, and clindamycin alone have poor activity against Pasteurella multocida and should be avoided 2
Intravenous options for severe infections include β-lactam/β-lactamase combinations, piperacillin-tazobactam, second-generation cephalosporins, or carbapenems 2
Antibiotic prophylaxis is particularly important for hand wounds 2
Antibiotic prophylaxis is particularly important for wounds involving joints, tendons, ligaments, or fractures 2

Infectious complications include septic arthritis, osteomyelitis, subcutaneous abscess formation, tendonitis, and rarely bacteremia 2
Pain disproportionate to the severity of injury near a bone or joint may suggest periosteal penetration 2
Hand wounds often have more serious complications than wounds to fleshy parts of the body 2
Capnocytophaga canimorsus can cause bacteremia and fatal sepsis, especially in patients with asplenia or underlying hepatic disease 2

Dog bite wounds are typically polymicrobial with mixed aerobic and anaerobic bacteria 2
Common pathogens include Pasteurella species, isolated from 50% of dog bite wounds 2
Staphylococci and streptococci are found in ~40% of bites 2
Anaerobes including Bacteroides species, fusobacteria, Porphyromonas species, and peptostreptococci are common in dog bite wounds 2

Administer tetanus prophylaxis as indicated based on the patient's immunization status 1