Animal bites are a significant burden to health care systems worldwide. In the United States, dog bites account for an average of 337,000 emergency visits and generate medical costs of up to $2 billion per year. Most animal bites in adults and children are from a dog, and most bite patients are children who have been bitten by animals known to them. Dog bites may cause crush and soft-tissue avulsion, whereas cat bites usually cause deeper puncture-type wounds. Children most often present with dog bites on the head and neck, and adolescents and adults usually present with dog bites on the extremities and hands. Bite wounds should be examined, cleaned, and irrigated with warm water or normal saline solution, and any foreign bodies and devitalized tissue should be removed. Neurovascular function (e.g., pulses, sensation) and range and movement of adjacent joints should be examined and documented. Antibiotic prophylaxis, with amoxicillin/clavulanate as the first-line choice, should be considered for all bites, particularly for those at increased risk of infection. Imaging and laboratory studies are usually not required unless there is suspicion of a retained foreign body, damage to underlying structures, infection, or extensive injury. Primary closure of bite wounds may be performed if there is low risk of infection. The need for tetanus vaccination and rabies postexposure prophylaxis should be evaluated for each patient; bites that do not break the skin generally do not require rabies postexposure prophylaxis.
Dog and cat bites are a common presentation in primary care clinics and emergency departments worldwide. This article summarizes the best available evidence for the evaluation and management of dog and cat bites.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Evidence rating | Comments |
|---|---|---|
| Patients at increased risk of infection from dog and cat bites should receive antibiotic prophylaxis.10,17–19 | C | Expert opinion and consensus guidelines |
| The need for tetanus vaccination and rabies postexposure prophylaxis should be assessed in each patient presenting with a dog or cat bite.10–12 | C | Risk of rabies exposure varies worldwide and by region; clinicians should consult local guidelines |
| Primary closure may be performed at the time of injury for dog bite wounds at low risk of infection; wounds that are at risk of infection should be allowed to heal by secondary intention.10,21 | B | Meta-analysis and a Cochrane review with inconsistent conclusions |
| Injuries to underlying structures (e.g., tendons, joints, bone) and those that could lead to scarring warrant referral for possible surgical exploration and repair.11,12,15,27 | C | Expert opinion |
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 https://www.aafp.org/afpsort.
Epidemiology
- In the United States, dog bites account for an average of 337,000 emergency visits per year.1 The burden on the health care system is higher in developing regions. For example, in Latin America, approximately 1 million people seek care annually for possible exposure to rabies from dog bites. This means that with a population of about 540 million people, 1 in 500 of the region's inhabitants were bitten by a dog and sought care to prevent rabies in one year.2 Most animal bites in adults and children are from a dog.1
- Estimates suggest that 20% of patients with an animal bite in the United States seek care in health units.3 Approximately 800,000 cases of dog bites require some type of medical attention and generate $2 billion in medical costs per year.4–6
- Dog and cat bites are most common in male, school-aged children. Most bites involving infants and preschoolers occur in their homes with a dog the child is familiar with, whereas adolescents are more often bitten by unfamiliar dogs.4,5,7
- There is significant regional variation in hospitalization rates for dog bites. In England, the highest hospitalization rates occur in underprivileged areas (27 per 100,000 people).8 Children are more likely than adults to receive medical care for these injuries.9 Children younger than nine years are disproportionately affected by dog bites (17.6 per 100,000 children) and account for two-thirds of hospital admissions among those younger than 18 years.8
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