Possible complications of dog bite wounds:
(1) local cellulitis or abscess
(2) osteomyelitis or septic arthritis
(3) bacteremia
(4) endocarditis
(5) meningitis and/or brain abscess
Indications for prophylaxis:
(1) moderate to severe injury
(1a) if edema or crush injury is present
(1b) with deep and puncture-type wounds, which are difficult to irrigate and debride
(2) if there is possible bone, tendon or joint penetration
(3) if the wound is adjacent to a prosthetic joint
(4) with wounds involving the hand or feet
(5) if the wound is in the genital area
(6) in high risk patients
(6a) in immunocompromised patients
(6b) patients on steroid therapy
(6c) after mastectomy
(6d) patients with liver disease
(6e) patients with edema of an extremity
(6f) patients with lupus erythematosus
Therapeutic Recommendations
Organisms include
(1) Pasteurella multicida or other Pasteurella species
(2) Capnocytophaga canimorsus (DF-2)
(3) streptococci and enterococci
(4) Staphylococcus aureus and coagulase negative species
(5) anaerobic bacteria
(6) Eikenella corrodens
(7) Acinetobacter species
(8) Actinobacillus actinomycetemcomitans
(9) Neisseria species
(10) Hemophilus species
(11) Corynebacteria
Antibiotic selection:
(1) ampicillin/sulbactam
(2) cefoxitin
(3) similar agents, preferably providing beta-lactamase coverage
Prophylaxis should start as soon as possible after the injury, preferably less than 8 hours after the bite.
Additional concerns:
(1) tetanus prophylaxis
(2) rabies prophylaxis
(3) need to elevate the involved extremity if any edema is present
(4) immobilization or splinting of affected area
