A 5-year-old boy is brought into the ER immediately after an unfortunate altercation with a neighbor's immunized Chihuahua that occurred while the child was attempting to dress the dog as a superhero. The fully immunized child has a small, irregular, superficial laceration on his right forearm that has stopped bleeding. His neuromuscular examination is completely normal, and his perfusion is intact. Management should include which of the following?
Mammalian bites should be promptly and thoroughly scrubbed with soap and water and debrided. The decision to suture depends on the location, age, and nature of the wound. Antibiotic prophylaxis is extremely controversial. Most experts suggest a short course of antibiotics should be started for cat, human, or monkey bites. Only 4% of dog bites become infected (and therefore do not necessarily need antibiotic prophylaxis), compared with 35% of cat bites and 50% of monkey bites (which require antibiotics in most cases). Cat bites are usually deep punctures. Human bites almost invariably become infected.The etiologies of these infections are polymicrobial. Pasteurella multocida is a common organism in infected cat and dog bites. Infected human bites tend to have positive cultures for S viridans, S aureus, and Eikenella corrodens. Treatment with amoxicillin-clavulanate orally or ampicillin- sulbactam IV is recommended. Antibiotic prophylaxis is recommended for any bite sustained by an infant, a diabetic, or an immunocompromised patient because of the higher risk of infection in these persons. Since the child is fully immunized, tetanus boosters are not required. Similarly, as the dog was provoked and was fully immunized, rabies should not be a concern.
Irrigation and antimicrobial prophylaxis
Tetanus booster immunization and tetanus toxoid in the wound
Copious irrigation
Primary rabies vaccination for the child
Growth, Development, and Behavior