BMJ 2007;334:413-417 (24 February), doi:10.1136/bmj.39105.659919.BE
Clinical Review
Dog bites
Marina Morgan, consultant medical microbiologist1,
John Palmer, consultant plastic and reconstructive surgeon2
1 Old Pathology Laboratory, Royal Devon and Exeter Foundation Trust, Exeter EX2 5AD,
2 Department of Plastic and Reconstructive Surgery, Royal Devon and Exeter Foundation Trust, Exeter
Correspondence to: M Morgan marina.morgan@rdeft.nhs.uk
| The first 150 words of the full text of this article appear below. |
Bites and maulings by dogs, sometimes fatal, are a worldwide problem and particularly affect children. Every year 250 000 people who have been bitten by dogs attend minor injuries and emergency units in the United Kingdom,1 and some of them are admitted to hospital for surgical debridement or intravenous antibiotics.
SUMMARY POINTS
- Wound management is as important as use of antimicrobials in preventing infection
- Primary closure should be avoided in limb injuries where possible because of increased risk of infection
- For patients considered to be at higher risk of infection, the prophylaxis of choice is co-amoxiclav
- Erythromycin or flucloxacillin should never be used alone prophylactically as Pasteurella infection is usually resistant
- Infected wounds presenting within 12 hours of injury are usually due to Pasteurella multocida
- Patients at particularly high risk of infection are immunosuppressed patients, particularly those with asplenia or cirrhosis or those who have had a mastectomy
| |
Increasingly, dog bites are . . . [Full text of this article]
Sources and selection criteria
How big is the problem?
Why do dogs bite?
What are the medicolegal aspects of dog bites?
How should dog bites be managed?
Box 1 Points to consider during history and examinationHistoryExaminationBox 2 Procedures for initial wound managementBox 3 Factors that increase risk of infection* Patient factorsWound factorsBox 4 Indications for referral to specialist care9Head and neck bitesExtremity and hand bitesWhich infections result from animal bites?
Box 5 Characteristics of Pasteurella multocidaWhen should prophylactic antibiotics be used in dog bites?
Meta-analyses
Box 6 Indications for antimicrobial prophylaxis"High risk" wounds"High risk" patients (conditions)9w1Treatment of established infection
Duration of treatment for established infection
Rabies
Risk assessment in travellers returning with dog bites
Box 7 Who to contact about risk and management of rabies Prevention
ADDITIONAL EDUCATIONAL RESOURCES Resources for healthcare professionalsResources for patients

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