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Point | Counterpoint – Dog Bites Do Not Need Antibiotics

July 27, 2020

Written by Clay Smith

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Treating dog bites with antibiotics to prevent infection may not be beneficial and may result in antibiotic related side effects and promote resistance.

Why does this matter?
Use of antibiotics for dog bites is controversial. They are less likely than cat or human bites to become infected. Is the benefit worth the risk?

The authors point out that an early meta-analysis had included studies at high risk of bias and one which included other types of bites than dog. They also point out that a Cochrane review found no benefit. And a later small RCT also found no benefit. They note it would take a large RCT to show benefit or harm since the overall infection rate is low. They expressed concern for adverse drug events, which are commonly caused by antibiotics and the very real risk of increasing antibiotic resistance with overuse of broad spectrum antibiotics. It is not one-size-fits-all. Some may benefit, such as patients who are, “older than 50 years, have major puncture wounds, have wounds requiring extensive debridement, have bite wounds that are sutured, have bites to the hands, or are immunocompromised (eg, have diabetes mellitus, are undergoing chemotherapy, are receiving immunosuppressing agents).” They also suggest that since Pasteurella infection usually occurs rapidly, that a shorter course of 3 days may be adequate if antibiotics are use.

Prophylactic Antibiotics Are Not Routinely Indicated for Dog Bites. Ann Emerg Med. 2020 Jul;76(1):86-87. doi: 10.1016/j.annemergmed.2020.01.030.

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