Management of Pediatric Dog Bites

Initial Wound Management

The American Academy of Pediatrics and other medical societies recommend immediately washing and flushing all bite wounds thoroughly with soap and water for approximately 15 minutes to reduce infection risk and potential rabies transmission 1
Wounds should be carefully examined for tendon or bone involvement, and potential joint penetration, which may be indicated by pain disproportionate to injury near a bone or joint 1, 2
The decision to suture wounds should consider cosmetic factors, such as facial wounds, which may be closed if seen early and properly cleaned, as well as the risk of bacterial infection and timing of the wound 1, 2

The Infectious Diseases Society of America recommends amoxicillin-clavulanate as the first-line prophylactic antibiotic for dog bite wounds 1
Alternative oral agents for penicillin-allergic patients include doxycycline, fluoroquinolone plus an agent active against anaerobes, and clindamycin plus a fluoroquinolone 1
Antibiotic prophylaxis is particularly important for hand wounds, wounds over tendons or bones, and immunocompromised patients 1

The Centers for Disease Control and Prevention recommend assessing the need for rabies prophylaxis based on the vaccination status of the dog, circumstances of the bite, and whether the dog can be observed for 10 days 3
If rabies prophylaxis is indicated, administer both rabies immune globulin and rabies vaccine, with the first dose of vaccine given as soon as possible after exposure 3, 4

The American Academy of Pediatrics recommends assessing tetanus immunization status and administering tetanus prophylaxis as indicated, with tetanus toxoid given to patients with unknown or incomplete tetanus immunization 1, 2

Infectious complications include septic arthritis, osteomyelitis, subcutaneous abscess formation, tendonitis, and bacteremia, which can be caused by a variety of bacteria, including Pasteurella species, Staphylococci, and anaerobes 1, 2
Capnocytophaga canimorsus can cause bacteremia and fatal sepsis, especially in patients with asplenia or underlying hepatic disease 1