Dog Bites
- Soft tissue infections following dog bites are not as common as after cat and human bites, because they have bigger teeth and wounds are larger.
Cat Bites
- Cat bites tend to be heavily contaminated!
- Cats can leave small, deep punctures that penetrate all the way to bone, because cats have long, sharp and narrow teeth. Cat teeth can also break off in the wound.
- 2/3 of cat bites involve the upper extremities
Bugs
- Pasturella multocida (GNR)
-50% dog bites
-75% cat bites
- Strep viridans
- Bacterioides
- Fusobacterium
- Capnocytophaga
Treatment
- Xray injuries to make sure no foreign bodies are in wound
- Copious irrigation and debridement if necessary
- Empiric preventative antibiotics
-Augmentin has been shown to prevent infection in pts who present at greater than 8 hours after bite.
-Also, it needs to be given in more severe wounds, deeper wounds, wounds close to a joint, wounds on the face, wounds requiring surgical repair and wounds in immunocompromised
-Administer 875/125 mg BID in adults and 20 mg/kg/dose BID in kids for 3-5 days
-Second line agents that cover pasturella include doxycycline, TMP-SMX, penicillin, moxifloxacin. Cover anaerobes with flagyl or clindamycin.
-Do NOT give cephalexin, dicloxacillin, or erythromycin as these do not cover pasturella
- Loose closure of facial dog bites is acceptable in an experienced practitioner's hands due to lower probability of infection
- Cat bites on the face should be loosely approximated because of low rate of infection due to high vascularity of head and face.
- Axial or extremity cat bites are managed with delayed primary closure or secondary intention healing due to higher risk of infection.
- Tetanus prophylaxis should be administered; observe animal for rabies as only 0.1-2% are rabid (give vaccine regimen if wild animal or high suspicion of rabies)
from Amy Murphy MS4
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