Surgical toilet, appropriate antibiotics, and advice to come back if infection develops

Mammalian bites have a sinister reputation for causing tissue damage and infection. Although human bites have the greatest potential for local injury–because of the varied and virulent flora of pathogenic organisms in the mouth and the propensity for association with a crush injury–dog bites are numerically the most common.1 They account for 1-2 million injuries in America each year2 and about 200 000 cases in Britain.3 In addition, many victims regard their injury as too insignificant to seek medical help initially. A small number may then go on to develop overwhelming systemic infection, as reported in this week's BMJ by Mellor et al (p 129).4 This suggests that dog bites can only be regarded as trivial in retrospect. What then should be the advice to patients, general practitioners, minor injuries units, and accident and emergency departments in terms of safe guidelines for management?

The treatment of dog bites is twofold: proper surgical toilet and appropriate antibiotic treatment where indicated. Wound toilet remains the mainstay of treatment of all bite injuries, whether this means adequate cleaning of a superficial wound by the patient at home or the full exploration, debridement, and irrigation of a more extensive injury under local, regional, or general anaesthesia. The …