Dog Bite Management

Antibiotic Selection

The American College of Physicians and Infectious Diseases Society of America recommends amoxicillin-clavulanate as the first-line antibiotic for dog bite wounds, due to its efficacy against polymicrobial flora, including Pasteurella multocida, staphylococci, streptococci, and anaerobes 1, 2, 3
Alternative oral regimens, such as doxycycline, penicillin VK plus dicloxacillin, fluoroquinolones, and trimethoprim-sulfamethoxazole, can be used if amoxicillin-clavulanate is unavailable or contraindicated 1, 2
Antibiotics to avoid include first-generation cephalosporins, penicillinase-resistant penicillins, macrolides, and clindamycin alone, due to their poor activity against Pasteurella multocida 1, 2, 3

Dog bite wounds yield an average of 5 bacterial species, with approximately 60% containing mixed aerobic-anaerobic bacteria 1, 2, 3
Pasteurella species are isolated from 50% of dog bite wounds, while staphylococci and streptococci are found in approximately 40% of dog bites 1, 2, 3
Anaerobes, such as Bacteroides, Fusobacteria, Porphyromonas, Prevotella, and Peptostreptococci, are present in 50% of cases 1, 2, 3

Thorough cleansing with soap and water, followed by povidone-iodine solution irrigation, can reduce infection risk and rabies transmission 4, 5, 6
Debridement of devitalized tissue and removal of foreign bodies is essential for proper wound care [1, 2
Avoid suturing when possible, as infected wounds should never be closed 6, 1, 2

Tetanus immunization status must be assessed for all bite wounds, and tetanus toxoid should be administered if vaccination status is outdated or unknown 4, 5, 6, 1, 2

Healthy domestic dogs may be confined and observed for 10 days rather than immediate euthanasia 4, 5, 6
Unprovoked attacks are more likely to indicate rabies risk, and currently vaccinated dogs are unlikely to transmit rabies 4, 5, 6
If rabies exposure is suspected in previously unvaccinated persons, administer both rabies immune globulin and vaccine on days 0, 3, 7, 14, and 28 6

Osteomyelitis requires 4-6 weeks of antibiotic therapy, while septic arthritis requires 3-4 weeks 1, 2

Failing to recognize hand wounds as high-risk, using inadequate antibiotic coverage, and premature wound closure can lead to treatment failures and increased infection risk 1, 2, 6