Bites: dogs: prophylactic antibiotics prevented wound infection.

Clinical bottom line (level 1a)

  1. Prophylactic antibiotic administration for dog bite wounds prevented wound infection (NNT = 15 at unknown) .
  2. Patients with a dog bite of the hand may be at higher risk of infection (NNT = 5 at unknown)
Cummings : Annals of Emergency Medicine 1994; 23 (3): 535-540
Expires November 2004

The study

Systematic review of randomised controlled trials of
  • Patients: uninfected dog bites
  • Intervention: oral antibiotics compared with placebo
  • Outcome: subsequent infections

Articles found in English using MEDLINE, 1966 to 1992 (search terms: 'bite', 'antibiotics', 'clinical trial' and 'dog' ) and bibliographies of review articles and original articles were searched for useful references.

Selection criteria: not detailed
Appraisal criteria: not detailed
Articles excluded if: not stated

Eight studies were found (six in the US and two in the UK). A meta-analysis was performed.
No significant heterogeneity was found.

The evidence

Outcome Time to outcome CER RR
(95% CI)		 NNT
(95% CI)
prevention of infection unknown 52/323
(16%)		 0.56
(0.38 to 0.82) 		15
(10 to 35)
a-priori sub group- hand bite: prevention of infection unknown 8/30
(27%)		 0.23
(0.05 to 0.95) 		5
(4 to 75)

Comments

  1. Need to consider cost-benefit analysis and consider restriction to patients at high-risk for infection (e.g. hand bites and sutured wounds).

Citation

  1. Cummings P, : Antibiotics to prevent infection in patients with dog bite wounds: A meta-analysis of randomized trials. Annals of Emergency Medicine 1994; 23 (3): 535-540
Search Terms: cellulitis and therapy
Contributor: John Epling and Chris Ball, November 2000
Reviewer: Sukanya Srinivasan

Clinical Question.
Patient dog bite
Intervention or Exposure prophylactic antibiotics
Outcome infection