Dog Bite Infection

1. See Also
   1. Dog Bite
   2. Animal Bite
2. Causes of Infection
   1. Pasteurella multocida (20-30% of all infections)
      1. Most common with infection <24 hours after bite
   2. Streptococcus
   3. Staphylococcus aureus
   4. Escherichia coli
   5. Anaerobes
      1. Bacteroides
      2. Fusobacterium
      3. Peptostreptococcus
   6. Capnocytophaga canimorsus (DF-2)
      1. Associated with severe infection
         1. Disseminated Intravascular Coagulation (DIC)
         2. Acute Renal Failure (ARF)
         3. Sepsis
      2. Risks
         1. Immunocompromised
3. Risk Factors for Infection
   1. Wound Type
      1. Crush Injury
      2. Puncture Wound
      3. Hand Wound
   2. Underlying Disease
      1. Chronic Disease
      2. Chronic extremity edema
      3. Diabetes Mellitus
      4. Immunosuppression
      5. Liver disease
      6. Prior Mastectomy
      7. Prosthetic Valve
      8. Prosthetic Joint
      9. Asplenia (post-splenectomy)
      10. Systemic Lupus Erythematosus (SLE)
4. Management: Outpatient antibiotics
   1. Antibiotic duration guidelines
      1. Prophylaxis after Dog Bite: 7 days
      2. Cellulitis Present: 10 to 14 days
   2. First Line antibiotics
      1. Amoxicillin-Clavulanate (Augmentin)
   3. Alternative Antibiotics for Penicillin Allergic
      1. Adults
         1. Doxycycline (do not use in pregnancy)
         2. Erythromycin (higher resistance rate)
         3. Combination protocol
            1. Clindamycin and
            2. Fluoroquinolone
      2. Children
         1. Erythromycin (higher resistance rate)
         2. Combination protocol
            1. Clindamycin and
            2. Trimethoprim-Sulfamethoxazole (Bactrim, Septra)
   4. Alternative Antibiotics for questionable compliance
      1. Ceftriaxone (Rocephin) IM qd
5. Management: Inpatient antibiotics
   1. Indications
      1. Systemic signs of infection (fever, chills...)
      2. Lymphangitis or lymphadenitis
      3. Rapidly spreading Cellulitis
      4. Advancement of Cellulitis past one joint
      5. Tenosynovitis
      6. Septic Arthritis
      7. Osteomyelitis
      8. Nerve involvement
   2. Intravenous Antibiotics for severe cases
      1. Nafcillin (with or without Gentamicin)
      2. Timentin
      3. Second generation Cephalosporin
      4. Third generation Cephalosporin
   3. Consultations to consider
      1. General Surgery
      2. Orthopedics
      3. Plastic surgery
6. References
   1. Gilbert (2001) Sanford Guide, p. 35
   2. Presutti (2001) Am Fam Physician 63(8):1567-72
   3. Presutti (1997) Postgrad Med 101:243
   4. Talan (1999) N Engl J Med 340:85-92