The major basis for recommending co-amoxiclav is in-vitro sensitivity data of organisms related to dog bites, and most authorities recommend using prophylactic antimicrobials in selected patients at high risk of infection. Overall, the clinical approach in the UK to management of dog bites is pragmatic and based largely on consensus opinion rather than firm evidence. The basic principles of wound management and indications for use of antimicrobials and rabies prophylaxis apply to clinicians in all countries, but the primary focus of this article will be the UK. This review is aimed at clinicians who deal with dog bites. w1 w2 Large wounds, significant devitalisation, and high mortality can result, with the highest mortality in neonates (six times that in toddlers), who are usually bitten by household pets.
The biting force of canine jaws varies with the breed, from 310 kPa to nearly 31 790 kPa in specially trained attack dogs. The “hole and tear” effect-whereby canine teeth anchor the person while other teeth bite, shear, and tear the tissues-results in stretch lacerations, easily piercing immature cranial bones.
Increasingly, dog bites are the subject of litigation because bite wounds are still being sutured when they should be left open and because of incorrect antimicrobial prophylaxis. Patients at particularly high risk of infection are immunosuppressed patients, particularly those with asplenia or cirrhosis or those who have had a mastectomy
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