Dog bites result in hundreds of thousands of
emergency room visits a year in the United States; the majority of folks bitten by dogs are kids, and they are often bitten by a neighbor's dog. In a culture where dogs are cherished as much by their owners as children are by their parents, local feuds erupt, and often
end up in court.
By the time a physician sees a dog bite, the damage has been done. Some infections will result. Many children will need to be hospitalized for intravenous antibiotics. Many children will have scars.
Why are dog bites so prone to infection?
1) The flora partying in a dog's mouth boggle the mind. Watch a dog go about his day--he uses his tongue like we use our hands, though with a little less thought. Lick the floor, lick their balls, hey, some poop, might as well lick that, too! If Fido's thirsty, well, what's a toilet for? A dog's mouth is full of anaerobic bacteria, the sort that flourish in a low oxygen environment.
2) Dog bites can exert a pressure of a couple hundred pounds per square inch. A crush injury means less blood flow to the injured area. Without blood flow, little oxygen can get to the area. The white blood cells, essential for fighting infection, cannot get to the bacteria.
3) Dogs have pointy teeth, leading to punctures. (Why do you think our pointy teeth are called canines?)The puncture wounds quickly seal up, trapping bacteria inside. (Cats have even pointier teeth, one reason cat bites are so dangerous.)
What can you do?
First, avoid getting bit. No one wants to hear it after the fact, but maybe trying to pull the stuffed rabbit away from a Rottweiler by your teeth shows questionable judgment.
Once bitten, stop the bleeding. Apply direct pressure. Remember, all bleeding eventually stops. Do not keep peeking. Wash the wound with soap and water, then apply a sterile bandage. Call the doctor. Trust me, doctors would rather get involved earlier, before the 3 AM call about a throbbing hand the size of a melon.
You can apply topical antibiotic, but this will not do a whole lot of good for deep puncture wounds. Still, it gives you something to do, and it gives your mother a chance to look at the wound.
If you are behind in your tetanus shots, or if there is any reason to be suspicious of rabies in your neck of the woods, seek medical help.
What can the doctor do?
Doctors see a lot of infected dog bites. A doctor may not be quite as gentle cleaning out a wound as a family member might be. Doctors also have nifty toys that can force sterile saline into wounds to remove as much bacteria and dead flesh as can be reasonably removed.
You might need a radiograph to look for bone injury.
In rare cases, your doctor might suture the wound. Please be aware, however, that suturing increases the chance of wound infection. Closing the wound limits air, which helps the anaerobic bacteria to thrive. If extensive damage has been done, a surgeon will do what she can to put the pieces back together.
If the wound is on the hand or face, the doctor will likely prescribe an oral antibiotic to help prevent infection. The oral drug of choice is a combination drug amoxicillin/clavulonic acid (Augmentin), which covers most of the bacteria likely to be a problem. If you are allergic to penicillin, you may need to take more than one drug.
If your last tetanus shot was more than 5 years ago, you may get a booster. If you are a toddler who has had fewer than 3 tetanus shots, you may need tetanus immune globulin.
If the dog has not been captured and rabies is endemic in your area, you may need a series of rabies shots.
The doctor will tell you to watch for signs of infection--redness, swelling, warmth, pain, or fever. She will tell you to keep your wound elevated--this helps minimize the swelling, allowing better blood flow. She will likely want to see you again in a day or two to check the wound.
What if, despite all, it gets infected
If there's a pocket of pus (abscess), time to open and drain. If the hand or face are involved, you will likely be admitted for intravenous antibiotics. If the wound has already been sutured, the stitches need to come out. The doctor will try to get some pus to culture the predominant bacteria, which will help determine which antibiotics to use. If fever is present, the doctor will obtain a blood culture as well.
If the wound is extensive, or if the infection is spreading, a surgeon will open the wound and debride the dead tissue.