By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

PROPER CARE OF A DOG BITE CAN PREVENT WOUND INFECTION AND RABIES

Question: A friend of mine got bitten by her dog recently. She didn’t go to the doctor because it was her dog and she didn’t think the bite was very bad. She got a terrible infection and ended up in the hospital. She is OK now, but could you discuss care of a dog bite please so others won’t make the mistake that she did?

Answer: There are over 4 million animal bites in the United States annually. About 80 to 90 percent of them are from dogs. While most people recover fully from dog bites, there are about a dozen dog bite fatalities every year. Certain breeds are more likely to bite, but any dog will bite if it is provoked, feels threatened or is trained to be aggressive.

While most dog bites will heal well with good cleansing after the bite, about 20 percent of the time they become infected, and some infections can be very severe as your friend found out. When a dog bites, it causes puncture wounds to the skin as well as a “crush type” injury to deeper tissues.

A good cleansing should start with an immediate washing of the entire area of the bite with soap and water. A bandage should then be applied to keep the wound area clean. If the punctures are deep, then a visit to the emergency department of a local hospital or an urgent care center is in order. There, the deep wounds can be irrigated under local anesthetic.

People with deep wounds are usually started on an antibiotic to prevent infection. The wounds are not sutured, but left to heal “from the bottom up.” The exception to this is dog bites to the face. These are usually cleaned very well and sutured to prevent excessive scarring. Older people and those with certain medical conditions -- diabetes, cancer or other immunosuppressive illnesses -- should always contact their physician, even if the injury is not severe, because these groups have an increased risk for infection.

Another concern with any animal bite is rabies. Rabies is a viral infection that, once symptoms have begun, is virtually always fatal. It is most often spread from a rabid animal to a human through infected saliva when the human is bitten. That’s why you should always find out if the animal that bit you is up to date on its rabies shots. If not, you should contact your doctor or the county health department for advice. They may want to quarantine the animal and/or instruct you to get immune globulin and rabies vaccine.

Immune globulin contains some “ready to go” antibodies to rabies from other humans who have a high antibody count against this disease. This will be followed by the rabies vaccine, which stimulates your own body to produce rabies antibodies. The rabies vaccine is a series of five shots that are given at specific intervals. While you may have heard stories about having to get shots “in your stomach,” the modern vaccine is given in your arm -- like a flu shot -- and is usually just as painless.

Of course, the best treatment for a dog bite is prevention. Do not approach strange dogs. Do not bother animals who are eating or sleeping. Also, mother dogs with puppies are very protective of their litters and should be left alone. If you are startled by a dog, do not scream or run as this will likely increase the dog’s aggression.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.