Dog and Cat Bites



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Am Fam Physician. 2014 Aug 15;90(4):239-243.

This clinical content conforms to AAFP criteria for continuing medical education (CME). See the CME Quiz Questions.

  Patient information: A handout on this topic is available at http://familydoctor.org/familydoctor/en/prevention-wellness/staying-healthy/pets-animals/cat-and-dog-bites.html.

Author disclosure: No relevant financial affiliations.

Animal bites account for 1% of all emergency department visits in the United States and more than $50 million in health care costs per year. Most animal bites are from a dog, usually one known to the victim. Most dog bite victims are children. Bite wounds should be cleaned, copiously irrigated with normal saline using a 20-mL or larger syringe or a 20-gauge catheter attached to the syringe. The wound should be explored for tendon or bone involvement and possible foreign bodies. Wounds may be closed if cosmetically favorable, such as wounds on the face or gaping wounds. Antibiotic prophylaxis should be considered, especially if there is a high risk of infection, such as with cat bites, with puncture wounds, with wounds to the hand, and in persons who are immunosuppressed. Amoxicillin/clavulanate is the first-line prophylactic antibiotic. The need for rabies prophylaxis should be addressed with any animal bite because even domestic animals are often unvaccinated. Postexposure rabies prophylaxis consists of immune globulin at presentation and vaccination on days 0, 3, 7, and 14. Counseling patients and families about animal safety may help decrease animal bites. In most states, physicians are required by law to report animal bites.

Animal bites account for 1% of emergency department visits in the United States, costing $53.9 million annually.1 Of the 4.7 million emergency department visits for animal bites every year, about 2% of patients need hospitalization.1 There are 10 to 20 animal bite–related deaths, mostly from dogs, annually.14

Dog bites account for 85% to 90% of animal bites in the United States at a rate of 103 to 118 per 100,000 population1,5; no one dog breed is most often responsible.6 Pit bull and Rottweiler breeds account for most of the human fatalities related to dog bites over the past two decades.6,7 Most dog bite victims are children, and these bites usually involve the head and neck. Adolescents and adults tend to have more bite wounds to the extremities.2,3,7 More than 70% of bites are from a dog that is known to the victim, and about 50% are self-reported as unprovoked.2

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendation Evidence rating References Comments

Bite wounds may be closed if cosmetically desirable. However, wounds at high risk of infection should be left open.

B

13, 14, 16

Randomized controlled trials

Antibiotic prophylaxis should be used for high-risk bite wounds and considered for average-risk wounds.

B

10, 16, 18, 19

Meta-analysis

Postexposure rabies prophylaxis should be given to all persons possibly 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-risk areas who are unlikely to get postexposure prophylaxis within 24 hours of a possible rabies exposure.

C

24, 26, 28

Evidence-based guidelines


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

View Table

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendation Evidence rating References Comments

Bite wounds may be closed if cosmetically desirable. However, wounds at high risk of infection should be left open.

B

13, 14, 16

Randomized controlled trials

Antibiotic prophylaxis should be used for high-risk bite wounds and considered for average-risk wounds.

B

10, 16, 18, 19

Meta-analysis

Postexposure rabies prophylaxis should be given to all persons possibly 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-risk areas who are unlikely to get postexposure prophylaxis within 24 hours of a possible rabies exposure.

C

24, 26, 28

Evidence-based guidelines


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

Cat bites account for 5% to 10% of animal bite wounds.1 Cat bites occur most often in adult women, usually on the extremities. Almost all of these bites are self-reported as provoked.2

Wound Treatment

Animal bite wounds are considered grossly contaminated; therefore, proper wound treatment is essential to prevent

The Authors

ROBERT ELLIS, MD, is an assistant professor in the Department of Family and Community Medicine at the University of Cincinnati (Ohio). He is the family medicine clerkship director and the interim director of medical student education.

CARRIE ELLIS, DVM, MS, is an associate veterinarian at the Animal Hospital on Mt. Lookout Square in Cincinnati.

Address correspondence to Robert Ellis, MD, University of Cincinnati, P.O. Box 670582, Cincinnati, OH 45267-0582 (e-mail: robert.ellis@uc.edu). Reprints are not available from the authors.

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