Case

A 7 year old girl is bitten by her dog who she inadvertently disturbed while he was eating. She received a laceration and comes to the office for care. There is a 3 cm. laceration n the left arm with some bruising around the area. How would you treat this patient?

Dog Bites

1. Most dog bites occur in school aged children 
2. Children have a higher incidence of facial and neck bites compared to adults
3. Most victims of dog bites know the dog, rarely are attacks by strays
4. Usually the dog is provoked and defending their territory
5. German shepherds are identified as the most frequent offenders
6. Bites tend to cause crushing and tearing injuries. About 5% of bites get infected.

1. Most bites are within the home and cats account for 10% of mammalian bites
2. Cat bites are puncture wounds and difficult to clean effectively. There is a higher incidence of infection compared to dog bites.

1. Supervise children around animals
2. Check the breed of dog before buying
3. Teach children the proper behavior around pets
4. Immunize the pets

1. Clean the bite area well and may need irrigation with saline.
2. Debrid any dead tissue around the wound
3. Fresh dog bites may be sutured or steri-stripped within 8-12 hours after occurring
4. All cat bites should be treated with antibiotics
5. Dog bites usually do not need prophylactic antibiotics unless they are difficult to clean, are on the hand, or there was a delay in getting care. Also treat wound that involve bone, tendons, joints, and high risk hosts.
6. Organisms to cover
1. Pasturella multocida from the dog's and cat's mouth which produces a cellulitis
2. Staphylococcal aureus which is on the skin and may produce a cellulitis
7. Antibiotics should cover both organisms. May use Dicloxacillin, Keflex, or Augmentin by mouth
8. Most bites can be treated at home but careful follow-up is suggested
9. Make sure that the child's tetanus status is up to date
10. Discuss the incidence of rabies with the family
11. Notify the police

1. Dire DJ. Emergency Management of Dog and Cat Bite Wounds. Emergency Medicine Clinics of North America. November 1992.
2. Garcia VF. Animal Bites and Pasturella Infection. Pediatrics in Review. 1997; 18:127-130.
3. Knapp JF. Updates in Wound Management for the Pediatrician. Pediatric Clinics of North America. 1999; 46(6):1201-1213.
4. Rapoport M and Adam HM. Animal Bites: Assessing Risk for Rabies and Providing Treatment. Pediatrics in Review. 1997; 18:142-143.
5. Rosekrans JA. Animal Bites: A Summertime Hazard. Contemporary Pediatrics, August 1993.
6. Talan et al.  Bacteriologic Analysis of Infected Dog and Cat Bites.  NEJM Vol 340 No. 2 Jan 14 1999
7. Fleisher Gary.  Management of Bite Wounds NEJM Vol 340 No. 2 Jan 14, 1999