An up-to-date article regarding dog and cat bites can now be accessed.

Am Fam Physician. 2014;90(4):239-243

The author has no significant financial associations to declare.

In the United States, dog bites result in 1% of emergency room visits, costing over $50 million every year. The majority of bites are from familiar dogs, with children being the primary victims. It is essential to clean and irrigate bite wounds with normal saline, examine for possible tendon or bone involvement, and close the wound if it can be done cosmetically. Antibiotic prophylaxis should be considered, especially for high-risk cases and potential rabies exposure. Post-exposure rabies prophylaxis involves immune globulin and vaccination. Providing advice on animal safety is crucial because physicians are legally obligated to report all animal bites.

Dog bites are the most common type of animal bites in the U.S., leading to significant hospital expenses and sometimes fatalities. Pit bull and Rottweiler breeds are most commonly associated with fatal cases. Children are usually the victims, with different bite patterns depending on age groups. Many bites are unprovoked and come from animals known to the victim.

Cat bites constitute a smaller portion of animal bites, usually affecting adult women on their extremities. These bites are typically reported as provoked.

Wound Treatment

Proper treatment of animal bite wounds is crucial to prevent infections, involving irrigation with water, saline, or povidone-iodine solution. Thorough debridement and exploration for foreign objects, tendon or bone involvement are essential. Radiography may be necessary for suspected cases, and tendon ruptures require precise assessment for possible referral.

In addition to wound irrigation and debridement, it is important to consider prophylactic antibiotics to prevent infection. Tetanus vaccination status should also be assessed and updated if necessary. Close monitoring of the wound for signs of infection, such as redness, swelling, or discharge, is necessary for early detection and treatment.

Wound Closure

There is conflicting evidence on the closure of animal bite wounds, with infection risks often leading to leaving wounds open, especially in specific situations outlined in Table 1.

For puncture wounds caused by animal bites, it is generally recommended to leave the wound open to allow for drainage and reduce the risk of infection. This is due to the nature of puncture wounds, which can easily trap bacteria deep within the tissue and lead to serious infections if closed prematurely.

However, in some cases where the wound is clean, properly debrided, and shows no signs of infection, primary closure may be considered. It is important to assess each wound on a case-by-case basis and consult with a healthcare professional for the best course of action.

Antibiotic Prophylaxis

Varied data exists on the efficacy of antibiotic prophylaxis for animal bite wounds, with different results reported. Staphylococcus, Streptococcus, Pasteurella, Capnocytophaga, Moraxella, Corynebacterium, Neisseria, and anaerobic bacteria are common pathogens associated with animal bites. Antibiotic prophylaxis should be considered for all bites requiring closure and those at high risk.

Amoxicillin/clavulanate (Augmentin) is typically the first-line treatment for animal bites, with treatment options summarized in Table 2. A three- to seven-day antibiotic course is generally adequate as seen in most studies. For adult patients, the first-line treatment is Amoxicillin/clavulanate (Augmentin), 875/125 mg every 12 hours. Clindamycin, Doxycycline, Penicillin VK, and other medications listed in the table are alternative options. For children, the recommended treatment is Amoxicillin/clavulanate, 25 to 45 mg per kg every 12 hours, with an alternate regimen also provided in the table. Pregnant women allergic to penicillin may consider Azithromycin as an alternative, with close monitoring necessary due to a high failure rate.

Tetanus vaccination is advised if more than five years have passed since the patient’s last immunization, with indications outlined in Table 3. Rabies, a potentially fatal virus, can infect any mammal. Postexposure prophylaxis is highly effective when administered correctly. Cats are the most common domestic animals infected, while raccoons, bats, and skunks are common wild carriers. Immediate vaccination is recommended for rabid or suspicious animals, with specific guidelines for postexposure rabies prophylaxis for various animal bites detailed in Table 4.

Educating individuals on pet-related health risks is critical, as studies show that a small percentage of primary care physicians provide counseling on this subject. Introducing dogs to children at a young age can help prevent bites, and regular veterinary visits and neutering contribute to reducing the incidence of bites.

Most regions in the U.S. require healthcare professionals to report dog bites and various other animal bites, even if the patients are seen in an outpatient setting. Physicians should be knowledgeable about state and local laws, as rabies in animals is a nationally notifiable disease, prompting the need to test suspected animals. Information on submitting and storing specimens can be obtained from local or state health departments.

Data Sources: Our search included the Cochrane database using keywords such as animal bite, bite wound, and rabies; the U.S. Preventive Services Task Force and Institute for Clinical Systems Improvement using specific terms related to animal bite, rabies, and bite wound; the Centers for Disease Control and Prevention using relevant keywords; and other reputable sources to ensure accuracy and comprehensiveness. Strategies included searches on Medline and in the Journal of the American Veterinary Medical Association. Search periods ranged from June 2011 to June 2014.

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Key facts

• Dog, cat, and human bites are the most common forms of bites requiring medical attention.
• Infections can occur if the skin is broken due to an animal bite.
• Avoid contact with bats or flying foxes in Australia unless properly trained, vaccinated, and wearing protective gear.
• If there is a chance of bat scratch or bite, seek immediate medical attention.
• Prior to overseas travel, discuss rabies risk with your doctor at least a month in advance.

Rodent bites can lead to infections and diseases such as rat bite fever, while farm animal bites, especially those from horses and cows, can cause serious injuries due to their size and strength.

Wildlife bites can also pose risks of rabies and other infections, making it important to seek immediate medical attention after any animal bite.

It is crucial to clean and disinfect animal bites thoroughly to prevent infections, and to seek medical treatment, including rabies vaccinations if necessary.

What symptoms are related to animal bites?

Animal bites are usually painful and sensitive to touch, presenting with teeth marks, abrasions, lacerations, puncture wounds, swelling, bleeding, pain, and infection.

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Snake bites

Snake bites can be venomous or non-venomous, depending on the type of snake. Venomous snake bites can be life-threatening and require immediate medical attention. In Australia, some of the most venomous snakes include the Eastern Brown Snake, Tiger Snake, and Red-bellied Black Snake.

If bitten by a snake, it is important to stay calm and seek medical help as soon as possible. Do not attempt to suck out the venom or apply a tourniquet, as these methods are ineffective and can make the situation worse.

Preventing animal bites

To prevent animal bites, it is important to properly train and socialize pets, especially dogs. Teaching children how to safely interact with animals and never leaving young children unsupervised with pets can help reduce the risk of bites. Avoiding wild animals and not approaching unfamiliar dogs or cats can also prevent bites.

It is essential to seek medical attention promptly if bitten by an animal, as infections can occur and some animals may carry diseases such as rabies or ABLV. Keeping up to date with vaccinations, especially for high-risk occupations or activities, can also provide protection against certain diseases transmitted through animal bites.

Other situations when you should see a doctor:

• If you have a fever or other signs of infection such as redness, warmth, or swelling around the bite
• If you have not received a tetanus shot in the last 5 years
• If you have a weakened immune system due to conditions such as diabetes, cancer, or HIV/AIDS
• If you develop symptoms of rabies, such as fever, headache, confusion, or excessive saliva production
• If you are pregnant or have a condition that affects your blood clotting ability

Remember, it’s always better to be safe than sorry when it comes to animal bites. Seek medical attention promptly to prevent any complications that may arise.

How are animal bites diagnosed?

Your doctor will conduct an examination, inquire about the bite, and may order a wound swab to check for infection or an x-ray if bone damage is suspected.

How are animal bites treated?

In case of a bite breaking the skin, seek immediate medical advice to prevent tetanus.

While minor animal bites can be managed at home, more serious wounds may require medical attention. The course of treatment depends on:

• the animal that caused the bite
• your vaccination history
• any signs of infection

Self-care at home

A minor bite wound can be treated at home with guidance from your doctor. It is recommended to:

• cleanse the area around the wound with soap and water
• try to remove any debris, hair, or teeth under running water
• apply pressure to make the wound bleed slightly to reduce infection risk
• pat the area dry with a clean cloth
• dress the wound with a clean bandage to prevent infection

If the wound is bleeding heavily, apply a dry bandage after cleaning.

Bat bites and scratches

In case of a bat bite or scratch in Australia, you should:

• thoroughly wash the wound with soap and water for at least 15 minutes
• apply antiseptic solution with antiviral properties like povidone-iodine or iodine tincture
• seek immediate medical attention and get vaccinated for Australian bat lyssavirus (ABLV)

Even if vaccinated for ABLV, it is essential to visit the hospital.

Medicines for animal bites

Your doctor might prescribe antibiotics to prevent or treat an infection.

Other treatments for animal bites

Your doctor may close the wound using stitches, adhesive strips, or special glue.

A tetanus booster shot may be recommended by your doctor.

In case of a human bite, blood tests may be suggested to check for:

If you have been bitten or scratched by a bat, vaccination against Australian bat lyssavirus (ABLV) is necessary promptly to avoid ABLV as it has no treatment once symptoms appear.

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How to prevent infection after an animal bite?

To prevent infection after an animal bite, it is important to:

• Clean the wound thoroughly with soap and water.
• Apply an antiseptic to the wound to kill any bacteria.
• Cover the wound with a clean bandage to prevent further contamination.
• Seek medical attention if the wound is deep, bleeding heavily, or shows signs of infection.
• Make sure your tetanus vaccination is up to date, as animal bites can increase the risk of tetanus.

Remember, even minor bites can lead to serious infections if not properly treated.

Can animal bites be prevented?

Prevent animal bites by educating your child on safe behavior around animals, especially dogs. Animals should never be disturbed while they are eating.

Choosing a less aggressive pet breed may lower the risk of being bitten.

Ensure your pets are up to date with their vaccinations.

Animal bites when travelling

When traveling, there is a risk of rabies exposure. The likelihood of exposure depends on your travel destination, with higher risks in Asia, Africa, and Central and South America.

To reduce the risk of rabies during travel:

• Discuss rabies vaccinations with your doctor at least a month before your trip
• Avoid contact with animals while abroad

Resources and support

The World Health Organization (WHO) provides a map of countries at high risk for rabies.

Contact the healthdirect helpline at 1800 022 222 (or NURSE-ON-CALL in Victoria) for assistance. A registered nurse is available 24/7.