by Bruna Olson, MD (’22)
Reviewed by Alison Heinly, MD (Pediatric Primary Care/Urgent Care)
Animal bites are a common complaint seen in the Emergency Department throughout the year. Questions regarding whether to manage the wounds through suturing or antibiotics are common and this article aims to clarify the indications for these different management options when appropriate.
While dog bites are much more common in children than cat bites, cat bites have a higher incidence of infection than dog bites. Another difference between dog bites and cat bites is the kind of injuries. While dog bites can vary from minor to major wounds, cat bites tend to penetrate deeply, which factors into their higher risk for infection.
Signs and symptoms of infection can present within hours to days after a bite. While most animal bite wounds are polymicrobial in nature, Pasteurella species (spp.), a facultative anaerobic gram-negative coccobacilli, is the most common organism isolated from both cat and dog bites. Cellulitis is the most common complication, but osteomyelitis, tenosynovitis, tendinitis, orbital cellulitis, or brain abscesses can also occur. Initial management should begin with cleaning and irrigation of the wound with soap, water and an antiseptic like povidone iodine to remove visible debris
Closure: So, when presented with an animal bite should we always suture?
The risk of infection versus cosmetics should always be weighed when deciding whether or not to close a bite wound, however there are cases where leaving the wound open to heal by secondary intention is indicated:
– Crush injuries
– Puncture wounds
– Cat bite wounds (facial wounds are an exception)
– Wounds involving the hands and feet
– Wounds ≥12 hours old (≥24 hours old on the face)
– Wounds in immunocompromised hosts (including diabetes)
– Wounds in patients with venous stasis
Prophylaxis: Do I need to treat it with antibiotics? How about tetanus and rabies?
Antibiotic: Amoxicillin-clavulanate is the antibiotic of choice for prophylaxis or empirical treatment of an animal bite. Clindamycin plus trimethoprim-sulfamethoxazole is an acceptable alternative for those with penicillin allergies. Antibiotic prophylaxis is recommended when:
– Lacerations undergoing primary closure and wounds requiring surgical repair
– Wounds on the hand(s), face, or genital area
– Wounds in close proximity to a bone or joint (including prosthetic joints)
– Wounds in areas of underlying venous and/or lymphatic compromise (including vascular grafts)
– Wounds in immunocompromised hosts (including diabetes)
– Deep puncture wounds or laceration (especially due to cat bites)
– Wounds with associated crush injury
Rabies: It is important to determine the risk of rabies exposure to determine the need for postexposure prophylaxis. We recommend assessing the risk of rabies exposure using the table below provided by the Pediatrics In Review article:
Tetanus: Determining the need for tetanus prophylaxis requires knowledge of the patient’s immunization status. Patients should receive human tetanus immune globulin and tetanus toxoid–containing vaccine if:
– They have an unknown tetanus immunization status
or
– They have received fewer than 3 doses of the tetanus toxoid–containing vaccine.
Patients should receive tetanus toxoid-containing vaccine only if:
– They have received 3 doses of tetanus toxoid–containing vaccine but the last dose was given ≥5 years ago.
References
1.Bula-Rudas, Fernando J., and Jessica L. Olcott. “Human and Animal Bites.” American Academy of Pediatrics, American Academy of Pediatrics, 1 Oct. 2018, pedsinreview.aappublications.org/content/39/10/490.
2. Baddour, Larry M. “Animal Bites (Dogs, Cats, and Other Animals): Evaluation and Management. Larry M Baddour, MD.” Uptodate, 25 Mar. 2021,
www.uptodate.com/contents/animal-bites-dogs-cats-and-other-animals-evaluation-and-management?search=animal+bite+children&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H1280072720.