All Dogs Bite Alexx Andria Read Online
Domestic dog and Cat Bites
Am Fam Physician. 2014 Aug 15;90(4):239-243.
Patient information: A handout on this topic is available at https://familydoctor.org/familydoctor/en/prevention-wellness/staying-healthy/pets-animals/true cat-and-canis familiaris-bites.html.
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Commodity Sections
- Abstract
- Wound Treatment
- Wound Closure
- Antibiotic Prophylaxis
- Rabies
- Preventing Animal Bites
- Laws and Regulations
- References
Canis familiaris bites account for ane% of all injury-related emergency department visits in the United states and more than $l 1000000 in inpatient costs per year. [ corrected] Most animate being bites are from a domestic dog, commonly one known to the victim. Near dog seize with teeth victims are children. Bite wounds should be cleaned, copiously irrigated with normal saline using a 20-mL or larger syringe or a 20-estimate catheter attached to the syringe. The wound should exist explored for tendon or bone interest and possible foreign bodies. Wounds may be closed if cosmetically favorable, such as wounds on the face up or gaping wounds. Antibiotic prophylaxis should be considered, specially if in that location is a high take a chance of infection, such every bit with cat bites, with puncture wounds, with wounds to the mitt, and in persons who are immunosuppressed. Amoxicillin/clavulanate is the first-line condom antibiotic. The need for rabies prophylaxis should exist addressed with any animal bite because even domestic animals are frequently unvaccinated. Postexposure rabies prophylaxis consists of immune globulin at presentation and vaccination on days 0, 3, 7, and 14. Counseling patients and families nearly fauna safety may help decrease animate being bites. In near states, physicians are required past law to report animate being bites.
Dog bites account for 1% of injury-related emergency department visits in the United States and an estimated $53.9 million in inpatient costs per year.1 Of the approximately four.v million persons who are bitten past dogs each twelvemonth, approximately 316,000 are treated in the emergency department, and nine,500 are hospitalized.1 [ corrected] There are ten to 20 brute bite–related deaths, mostly from dogs, annually.ane–4
Dog bites business relationship for 85% to xc% of creature bites in the U.s. at a charge per unit of 103 to 118 per 100,000 population1,5; no one dog breed is most ofttimes responsible.6 Pit balderdash and Rottweiler breeds business relationship for virtually of the human fatalities related to dog bites over the past two decades.6,7 About dog seize with teeth victims are children, and these bites usually involve the caput and neck. Adolescents and adults tend to have more bite wounds to the extremities.2,three,7 More than 70% of bites are from a dog that is known to the victim, and most 50% are self-reported as unprovoked.2
SORT: KEY RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Evidence rating | References | Comments |
|---|---|---|---|
| Bite wounds may exist closed if cosmetically desirable. However, wounds at high adventure of infection should be left open up. | B | 13, 14, 16 | Randomized controlled trials |
| Antibiotic prophylaxis should be used for loftier-risk bite wounds and considered for average-risk wounds. | B | ten, xvi, 18, 19 | Meta-analysis |
| Postexposure rabies prophylaxis should be given to all persons peradventure exposed to rabies. | C | 24, 26, 28 | Evidence-based guidelines |
| Preexposure rabies prophylaxis should be considered for persons at higher risk of rabies exposure, and for international travelers to at-run a risk areas who are unlikely to get postexposure prophylaxis inside 24 hours of a possible rabies exposure. | C | 24, 26, 28 | Evidence-based guidelines |
Cat bites account for 5% to ten% of animate being bite wounds.ane Cat bites occur most oftentimes in adult women, usually on the extremities. Nigh all of these bites are cocky-reported equally provoked.2
Wound Treatment
- Abstract
- Wound Treatment
- Wound Closure
- Antibiotic Prophylaxis
- Rabies
- Preventing Animal Bites
- Laws and Regulations
- References
Brute bite wounds are considered grossly contaminated; therefore, proper wound treatment is essential to foreclose secondary infection. The afflicted peel surface should be apple-pie, and the wound should exist copiously irrigated with water, normal saline, or dilute povidone-iodine solution, especially if the beast may be rabid.eight–ten To irrigate the wound, a 20-mL or larger syringe should be used to generate the loftier pressure required for adequate cleaning.10 If a 20-mL or larger syringe is unavailable, a xx-guess catheter tin be connected to the syringe to increase the pressure.9–xi Cautious debridement of debilitated tissue further decreases the potential for infection.ix,10,12
The wound should be advisedly explored for tendon or os involvement and foreign bodies, such every bit teeth fragments.9,10 Older dogs and cats often have significant periodontal affliction, increasing the risk that a tooth volition break off during a bite. Radiography is indicated if a foreign trunk or os involvement is suspected.9 Tendon ruptures should be evident on test, merely identifying a fractional tendon rupture requires careful exploration of the wound. Observing the tendon throughout the joint's full extension and total flexion can reveal small or partially torn tendons, which warrant referral for repair.
Wound Closure
- Abstract
- Wound Treatment
- Wound Closure
- Antibiotic Prophylaxis
- Rabies
- Preventing Creature Bites
- Laws and Regulations
- References
There are few studies addressing whether an creature bite wound should be primarily closed. Traditionally, creature bite wounds were left open to prevent secondary infections. In one study of 169 dog bite wounds in 96 patients, the infection rate was statistically equivalent for wounds that were primarily airtight (vii.6%) and those that were left to heal past secondary intention (7.eight%).13 In a second report of 145 bite wounds that were primarily closed, only 5.5% became infected, including bites from dogs (61%), cats (31%), and humans (viii%).fourteen Both of these studies are small and have pattern limitations; therefore, wounds may exist primarily closed if desired for cosmetic reasons.9,10,thirteen–xv However, allowing a wound to shut past secondary intention should be considered if there is a college hazard of infection (Table 1x,11,16), such as wounds to the manus.9,x The safety and effectiveness of skin adhesives have non been studied in animal bite wounds.17
Table i.
Factors That Increase the Run a risk of Infection from an Animal Seize with teeth
| Bite in extremities with underlying venous and/or lymphatic compromise | |
| Bite involving the hand | |
| Bite near or in a prosthetic articulation | |
| Cat bites | |
| Crush injuries | |
| Delayed presentation | |
| Greater than six to 12 hours for bites to the arm or leg | |
| Greater than 12 to 24 hours for bites to the face | |
| Puncture wounds | |
| Victim with diabetes mellitus or immunosuppression | |
Antibiotic Prophylaxis
- Abstract
- Wound Treatment
- Wound Closure
- Antibiotic Prophylaxis
- Rabies
- Preventing Beast Bites
- Laws and Regulations
- References
There are conflicting data regarding antibiotic prophylaxis in the handling of dog bite wounds and very limited data in other brute bite wounds. A meta-analysis of 8 randomized trials showed a do good with antibiotic prophylaxis in beast bites (relative risk = 0.56; number needed to treat = 14); the infection charge per unit was sixteen% in untreated patients.xviii However, a Cochrane review of nine trials showed no statistical difference in infection charge per unit between prophylaxis and no treatment, except in bite wounds to the mitt.19 In hand wounds, antibiotic prophylaxis reduced the rate of infection from 28% to 2% (odds ratio = 0.ten; number needed to treat = 4). However, studies were heterogeneous and used dissimilar antibiotics. Antibiotic prophylaxis should exist used for high-risk seize with teeth wounds (Tabular array 1ten,11,sixteen) and considered in average-chance wounds.ix,18,19
Cultures of seize with teeth wounds are by and large not helpful initially, unless the wound is abscessed or already infected.9,10 Common pathogens associated with creature bites include Staphylococcus, Streptococcus, Pasteurella, Capnocytophaga, Moraxella, Corynebacterium, Neisseria, and anaerobic leaner.20 Pasteurella multocida is a mutual bacterium in the mouths of cats, only information technology can also be present in dogs. This bacterium can crusade a fast-growing infection in humans and is one of the reasons to consider antibody prophylaxis for bite wounds. Wounds that become infected inside 24 hours of the bite are often caused past Pasteurella.10–12 Capnocytophaga canimorsus is an emerging human pathogen that has been isolated from the mouths of 24% of dogs and 17% of cats.10,12,21 This fastidious gram-negative bacterium can crusade septicemia, meningitis, and endocarditis. Patients who take had splenectomy or who corruption alcohol are at highest risk of C. canimorsus infection. A beta-lactam/beta-lactamase inhibitor combination is the initial treatment of choice for this bacterium.
Antibiotic prophylaxis should be considered for all bites requiring closure and for high-take a chance bites.ix,x All true cat bites are considered high risk for infection because they tend to crusade deep puncture wounds.9,x
Amoxicillin/clavulanate (Augmentin) is generally considered the starting time-line safety treatment for animate being bites.10,16 Tabular array two summarizes the handling options.x,sixteen,22 A three-solar day to seven-solar day grade of prophylactic antibiotics is likely acceptable and was typical in most studies.ix
Tabular array 2.
Prophylactic Antibiotic Dosages for Animal Bites
| Adults | |
| First-line | |
| Amoxicillin/clavulanate (Augmentin), 875/125 mg every 12 hours | |
| Alternatives | |
| Clindamycin, 300 mg 3 times per twenty-four hour period plus ciprofloxacin (Cipro), 500 mg twice per day | |
| Doxycycline, 100 mg twice per mean solar day | |
| Penicillin VK, 500 mg 4 times per twenty-four hour period plus dicloxacillin, 500 mg iv times per 24-hour interval | |
| A fluoroquinolone; trimethoprim/sulfamethoxazole, 160/800 mg twice per day; or cefuroxime axetil (Ceftin), 500 mg twice per day plus metronidazole (Flagyl), 250 to 500 mg 4 times per day, or clindamycin, 300 mg three times per day | |
| Children | |
| First-line | |
| Amoxicillin/clavulanate, 25 to 45 mg per kg divided every 12 hours | |
| Alternative | |
| Clindamycin, 10 to 25 mg per kg divided every half dozen to 8 hours plus trimethoprim/sulfamethoxazole, viii to 10 mg per kg (trimethoprim component) divided every 12 hours | |
| Pregnant women who are allergic to penicillin | |
| Azithromycin (Zithromax), 250 to 500 mg per twenty-four hours | |
| Close monitoring is needed considering of high failure rate | |
Tetanus vaccination is recommended after an creature seize with teeth if it has been more than five years since the patient has been immunized.eleven Table 3 summarizes the indications for tetanus prophylaxis in patients with wounds.23
Table three.
Indications for Tetanus Prophylaxis
| History of tetanus immunization | Make clean, minor wounds | All other wounds | ||
|---|---|---|---|---|
| Vaccine | Immune globulin | Vaccine | Immune globulin | |
| Uncertain or < 3 doses | Yes | No | Yes | Yeah |
| ≥ 3 doses | No, unless > x years since terminal dose | No | No, unless > v years since last dose | No |
Rabies
- Abstract
- Wound Treatment
- Wound Closure
- Antibiotic Prophylaxis
- Rabies
- Preventing Animal Bites
- Laws and Regulations
- References
Rabies is a virus that can infect any mammal. In the by decade, there have been up to 8 human being cases in the United States each yr.24 Once symptomatic, it is most universally fatal. Postexposure prophylaxis, which costs virtually $1,000, is 100% constructive if used properly.24 There have been half dozen,000 to vii,000 documented cases per year of rabies in animals in the United States and Puerto Rico over the past 10 years.25 In the United States, cats are the most usually infected domesticated brute, whereas raccoons, bats, and skunks are the most normally infected wild fauna. In 2012, in that location were 257 cases of rabies in cats and 84 cases in dogs.25 In most areas of the U.s.a., information technology is required by police that dogs and cats be vaccinated. Despite this, data evidence that merely 45% of dogs and 8% of cats that cause bites requiring an emergency department visit are vaccinated for rabies.2
Postexposure prophylaxis is indicated in all persons who were perhaps exposed to a rabid animal and is given to about xvi,000 to 39,000 persons in the United States each yr.26 Prophylaxis consists of immune globulin at presentation and rabies vaccination on days 0, 3, 7, and xiv. The allowed globulin is infiltrated around the seize with teeth wound, and any additional volume is administered at a site distant to the vaccination site, ordinarily the reverse arm as the rabies vaccine. In the by, a fifth dose of the vaccine was given on 24-hour interval 28; nonetheless, in 2009, the Advisory Committee on Immunization Practices recommended dropping this pace.24,27 If the patient had already received preexposure prophylaxis before the fauna bite, no immune globulin is needed, and the rabies vaccine is administered only on days 0 and 3.24
Postexposure prophylaxis is generally not needed in patients with a dog or cat seize with teeth equally long every bit the animal is not showing signs of rabies, such as inappetence, dysphagia, abnormal behavior, clutter, paralysis, altered phonation, or seizures; however, the animal should be monitored for at least 10 days.8,24,26,27 If the animal shows signs of rabies, becomes ill, or dies, firsthand postexposure prophylaxis is recommended. No animal should be euthanized within 10 days of biting someone so that information technology tin be properly observed. If there is a question near whether postexposure prophylaxis should be given, physicians can contact their local health department or go to http://www.cdc.gov/rabies/resources/contacts.html for a list of state and local rabies consultation contacts.
Preexposure prophylaxis should exist considered in persons with higher chance of rabies exposure, such every bit certain laboratory workers, veterinarians, spelunkers, and certain international travelers. The Centers for Illness Control and Prevention recommends that travelers to at-risk areas receive preexposure prophylaxis if they are unlikely to receive treatment within 24 hours of a possible exposure. Preexposure prophylaxis consists of three vaccines given on days 0, 7, and 21 to 28.26,28
Saliva, brain tissue, and nervous system tissue are considered infective. Blood, urine, and feces are not infective, and contact does not warrant postexposure prophylaxis. Table four includes postexposure rabies prophylaxis recommendations for specific animal bites.26 Postexposure prophylaxis should exist strongly considered in persons possibly exposed to a bat, such as if awakening from sleep and finding a bat in the room or finding a bat in the room with an unattended child.
Table 4.
Recommendations for Postexposure Rabies Prophylaxis
| Type of animal seize with teeth | Evaluation and disposition of animal | Recommendations |
|---|---|---|
| Dog, cat, ferret | Healthy; observe animal for 10 days | Vaccination should non be initiated unless the animal develops clinical signs of rabies |
| Rabid (or suspected) | Vaccination should begin immediately | |
| Unknown (e.g., escaped) | Public wellness officials should be consulted; immediate vaccination should be considered | |
| Raccoon, skunk, fox, other carnivore, bats | Regarded as rabid unless the creature tests negative | Consider immediate vaccination; if the beast is existence tested, delay vaccination until results are available |
| Livestock, horses | Consider individually | Public health officials should be consulted; most livestock in the United States are vaccinated for rabies |
| Rodent, rabbit, hare, other mammal | Consider individually | Public health officials should be consulted; bites of rabbits, hares, and small rodents (e.g., squirrels, hamsters, republic of guinea pigs, gerbils, chipmunks, rats, mice) almost never require postexposure rabies prophylaxis |
Preventing Animal Bites
- Abstruse
- Wound Treatment
- Wound Closure
- Antibody Prophylaxis
- Rabies
- Preventing Beast Bites
- Laws and Regulations
- References
Studies have shown that although most primary intendance physicians agree that counseling patients near pet-related health hazards is important, less than 20% counsel their own patients and family unit members.29 There are a few studies that demonstrate a benefit of counseling children and families about preventing dog bites.thirty Most dogs that seize with teeth are known to the victim.2–iv,half dozen,7 Dogs should be socialized to children from the time they are puppies. Training makes a canis familiaris more confident and less probable to bite out of fear. Pets should have regular veterinary visits to stay updated on vaccines and to improve wellness. Pets that are in pain or sick are more probable to bite. Neutering dogs has been shown to decrease bites. Young children should never be left alone with pets.31 A brochure on dog bite prevention from the American Veterinary Medical Clan is bachelor at https://www.avma.org/public/Pages/Dog-Bite-Prevention.aspx.
Laws and Regulations
- Abstract
- Wound Treatment
- Wound Closure
- Antibiotic Prophylaxis
- Rabies
- Preventing Fauna Bites
- Laws and Regulations
- References
Near areas in the U.s.a. require wellness intendance professionals to study dog bites and many other animal bites, including bites in patients who present to an ambulatory office. Physicians should exist familiar with their country and local laws. Considering rabies in animals is a national reportable disease, suspected animals should be sent for testing. Local or country wellness departments can provide information about submitting and storing specimens.
Data Sources: We searched the Cochrane database using the key words animal bite, bite wound, and rabies; the U.S. Preventive Services Chore Force and Found for Clinical Systems Improvement using the key words animal bite, rabies, and bite wound; the Centers for Illness Control and Prevention using the cardinal words animal bite and rabies; and the Agency for Healthcare Inquiry and Quality, National Guideline Clearinghouse, Essential Evidence Plus, and UpToDate using the fundamental word brute bite. Medline was searched when the other sources did not yield answers to our questions. We besides searched the Journal of the American Veterinarian Medical Clan. Search dates: June 2011, January 2012, June 2013, and June 2014.
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REFERENCES
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2. Centers for Affliction Control and Prevention. Nonfatal dog seize with teeth-related injuries treated in hospital emergency departments—United States, 2001. MMWR Morb Mortal Wkly Rep. 2003;52(26):605–610.
3. Gandhi RR, Liebman MA, Stafford BL, Stafford PW. Dog bite injuries in children: a preliminary survey. Am Surg. 1999;65(9):863–864.
4. Patrick GR, O'Rourke KM. Domestic dog and cat bites: epidemiologic analyses propose different prevention strategies. Public Health Rep. 1998;113(3):252–257.
5. Centers for Disease Control and Prevention. Spider web-based Injury Statistics Query and Reporting System. Nonfatal injury reports, 2001–2012. http://webappa.cdc.gov/sasweb/ncipc/nfirates2001.html. Accessed June 24, 2014.
6. Sacks JJ, Sinclair L, Gilchrist J, Golab GC, Lockwood R. Breeds of dogs involved in fatal human attacks in the United States between 1979 and 1998. J Am Vet Med Assoc. 2000;217(6):836–840.
7. Kaye AE, Belz JM, Kirschner RE. Pediatric canis familiaris seize with teeth injuries: a 5-year review of the feel at the Children's Hospital of Philadelphia. Plast Reconstr Surg. 2009;124(two):551–558.
8. Centers for Disease Control and Prevention. Rabies. http://world wide web.cdc.gov/rabies/medical_care/index.html. Accessed June 19, 2013.
9. Oehler RL, Velez AP, Mizrachi K, Lamarche J, Gompf South. Bite-related and septic syndromes acquired by cats and dogs [published correction appears in Lancet Infect Dis. 2009;9(9):536]. Lancet Infect Dis. 2009;9(vii):439–447.
10. Morgan M, Palmer J. Dog bites. BMJ. 2007;334(7590):413–417.
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xiv. Chen Eastward, Hornig S, Shepherd SM, Hollander JE. Primary closure of mammalian bites. Acad Emerg Med. 2000;7(2):157–161.
15. Paschos NK, Makris EA, Gantsos A, Georgoulis AD. Primary closure versus non-closure of canis familiaris bite wounds. a randomised controlled trial. Injury. 2014;45(one):237–240.
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17. Dermabond [package insert]. Somerville, North.J.: Ethicon, Inc.; 2003. http://www.ethicon360emea.com/sites/default/files/products/DERMABOND_Labeling.pdf. Accessed June 19, 2013.
18. Cummings P. Antibiotics to prevent infection in patients with dog bite wounds: a meta-analysis of randomized trials. Ann Emerg Med. 1994;23(3):535–540.
nineteen. Medeiros I, Saconato H. Antibiotic prophylaxis for mammalian bites. Cochrane Database Syst Rev. 2001;(2):CD001738.
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21. Tierney DM, Strauss LP, Sanchez JL. Capnocytophaga canimorsus mycotic abdominal aortic aneurysm: why the mailman is afraid of dogs. J Clin Microbiol. 2006;44(2):649–651.
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