If there’s any problem that arouses a parent’s anxiety, it’s a child with a dog bite! Emergency rooms, urgent care centers, and doctor’s offices see dog bites of all descriptions and locations nearly every day. It’s a traumatic event that children remember all their lives.
I vividly recall, at the age of five, the terror I felt being chased into my house by a neighbor’s dog. As a teenager I remember Buster, the huge German Shepherd across the street, who barked continually and tried, successfully at times, to break loose from the chain that confined him to the back yard. In more recent times, it was the huge dog that bit me in the buttocks when I was jogging on a country road. After that incident, whenever I ran I carried a metal rod.
“One percent of all ER visits are due to bites from a dog, usually one known to the victim.” Most victims are children who inadvertently put themselves in a vulnerable position. They disturb a dog while it is sleeping, interrupt its eating, or irritate it in some way that causes an angry reaction usually targeting the child’s head, neck or extremities.
I was taught that human bites are more likely to get infected than dog bites, but that doesn’t mean infection is not a concern. Bites on the hand are especially at risk for infection. Bacteria and foreign material can hide themselves and multiply rapidly in the many closed compartments in the hand. Bites on the face also present a risk of infection, but cosmetic damage is a bigger worry. Preventive antibiotics for dog bites depends on the location and circumstances of the bite.
Tetanus is mentioned here before rabies because, of the two, it is far more likely to occur. Tetanus prophylaxis (a shot) is always recommended after a dog bite. Rabies is a concern, of course, but skunks, bats, and raccoons carry rabies far more frequently than dogs. Rabies vaccination of dogs is mandated by law in most areas of the U.S. so it’s not a big problem. Inquiry as to the vaccination status of an offending dog is important in the decision to prescribe or not prescribe rabies prophylaxis. In forty years, I only prescribed rabies vaccine to one patient. That was to a young woman who was bitten by a “stray dog” while sitting in a bar on her honeymoon in Mexico! The vaccine cost $1600. Insurance paid only $140 of that. Health-wise she recovered with no further problem, but her HMO refused to pay for the vaccine. This is a prime example why doctors avoid HMO’s.
The wound(s) of a dog bite can be highly contaminated. They should be cleansed thoroughly with an iodine solution, vigorously irrigated, inspected for tendon or bone involvement, and examined carefully for fragments of teeth or other foreign material. After cleansing, closure of the wound is next, followed by tetanus prophylaxis. Then comes the decision whether or not to administer rabies vaccine. By determining the dog’s vaccination status, doctors can know if rabies vaccine is needed. Most domestic animals have been vaccinated, but if not, the dog, if it can be found, must be quarantined for 10 days to determine if it indeed has rabies. If the dog becomes ill, it is euthanized and examined for signs of rabies. My patient, bitten by an unknown dog in Mexico, had no way to know vaccination status, so the decision to vaccinate was made easily.
Years ago, the rabies vaccine series required painful shots for 14 straight days. The new series consists of immune globulin at the onset plus vaccine given on days 0, 3, 7, 14.
“Let a sleeping dog lie,” “let the big dog eat,” and “don’t bite the hand that feeds you,” are all appropriate phrases for keeping dogs happy and keeping their owners and children safe. Preventing dog bites by avoiding risky situations is wise advice for owners and lovers of dogs.
References: Desai AN, Dog Bites JAMA 2020 June23/30;323(24):2535.
Ellis R, Ellis C. Dog and Cat Bites Am Fam Phys 2014 Aug 15;90(4):239-243.
