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Point | Counterpoint – Dog Bites Need Antibiotics

July 28, 2020

Written by Clay Smith

Spoon Feed
The preponderance of limited evidence supports antibiotic use for dog bites, and the benefit outweighs the risk.

Why does this matter?
Treatment of dog bites is controversial. Yesterday, we considered the argument against routine use. Does use of antibiotics result in overall net benefit or harm?

Who let the dogs out?
These authors conclude that antibiotics should routinely be given to patients with dog bites. They open with the IDSA recommendation to use antibiotics in certain subgroups, such as patients with, “immunocompromise, asplenia, advanced liver disease, preexisting or resultant edema of the affected area, moderate to severe injuries (especially to the head or face), and injuries penetrating the periosteum or joint capsule.” They also explain that dog bites are contaminated with multiple virulent bacteria, such as Pasteurella and Capnocytophaga. They note the Cochrane review, mentioned yesterday, only found benefit for bites to the hand. But another meta-analysis came to the opposite conclusion and found significant benefit, NNT = 14. That publication included one study with a lax definition of infection and higher than expected infection rate. Regardless, they considered the conclusions credible. The authors agree that antibiotics have adverse effects but point out that the majority are mild, such as nausea or diarrhea. They acknowledge the limitations of the current literature in regard to its quality but think the preponderance of the evidence favors a short course of antibiotics for dog bites. This is my take: I prescribe antibiotics for dog bites in most cases. I think the risk of infection is low but significant when it occurs and think the benefit outweighs the risk for most cases. With antibiotics recommended for so many subgroups, including bites on the hand, and difficulty parsing out what constitutes “moderate or severe,” I usually err on the side of treatment.

Dog Bites are an Indication for Routine Antibiotic Therapy. Ann Emerg Med. 2020;76(1):85-86. doi:10.1016/j.annemergmed.2020.02.011

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What are your thoughts?