BMJ  2007;334:413-417 (24 February), doi:10.1136/bmj.39105.659919.BE

Clinical Review

Dog bites

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

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 examination
History
Examination
Box 2 Procedures for initial wound management
Box 3 Factors that increase risk of infection*
Patient factors
Wound factors
Box 4 Indications for referral to specialist care⁹
Head and neck bites
Extremity and hand bites

Which infections result from animal bites?

Box 5 Characteristics of Pasteurella multocida

When should prophylactic antibiotics be used in dog bites?

Meta-analyses

Box 6 Indications for antimicrobial prophylaxis
"High risk" wounds
"High risk" patients (conditions)^9w1

Treatment 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 professionals
Resources for patients

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