Management of Dog Bites

Evaluation and Initial Treatment

The American College of Physicians recommends that dog bites be cleaned immediately with copious irrigation using water or normal saline solution, which markedly decreases the risk of bacterial infection 2
Cleaning the wound is especially important in preventing rabies, as it can significantly reduce the probability of contracting the disease 2

The Infectious Diseases Society of America recommends that primary closure of dog bite wounds is not recommended, except for facial wounds 3
Facial wounds can be closed after copious irrigation, careful debridement, and administration of preventive antibiotics 1
For other wounds, consideration can be given to approximating the edges without complete closure 3
Hand wounds have a higher risk of infection if closed 1

The Infectious Diseases Society of America recommends early preventive antimicrobial therapy (3-5 days) for patients who are immunocompromised 4
The Infectious Diseases Society of America recommends early preventive antimicrobial therapy (3-5 days) for patients who are asplenic 5
The Infectious Diseases Society of America recommends early preventive antimicrobial therapy (3-5 days) for patients who have advanced liver disease 5
The Infectious Diseases Society of America recommends early preventive antimicrobial therapy (3-5 days) for patients who have pre-existing or resulting edema from the affected area 5
The Infectious Diseases Society of America recommends early preventive antimicrobial therapy (3-5 days) for patients who have moderate to severe lesions, especially on the hand or face 5
The antibiotic of choice is amoxicillin-clavulanate, which is active against aerobic and anaerobic bacteria 4

The Infectious Diseases Society of America recommends that tetanus toxoid be administered to patients who have not been vaccinated in the last 10 years 3
The Infectious Diseases Society of America prefers the Tdap vaccine over the Td vaccine if the former has not been previously administered 1
For dirty wounds, a booster is recommended if more than 5 years have passed since the last dose 3

Post-exposure prophylaxis for rabies may be indicated, and it is recommended to consult with local health authorities to determine if vaccination should be initiated 5
Post-exposure treatment includes rabies immunoglobulin and vaccine, regardless of the interval between exposure and treatment initiation 2