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Dog Bite Wound — MRCGP AKT MCQ

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EasyInfectious DiseasesDog Bite WoundMRCGP AKTUKMLAPARA

A 34-year-old man presents 2 hours after a dog bite to his hand. The bite has caused puncture wounds that broke the skin and drew blood. There is no neurovascular, tendon or joint involvement and no evidence of infection. He has no penicillin allergy. Which is the most appropriate oral antibiotic prophylaxis?

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Correct answer: B — Co-amoxiclav

Co-amoxiclav is the first-choice oral prophylactic antibiotic. NICE recommends prophylaxis when a dog bite has broken the skin and drawn blood and is a puncture wound; the hand is also a high-risk site. The usual adult prophylactic course is 3 days. Amoxicillin alone does not provide the recommended broad coverage for the mixed organisms associated with dog bites. Metronidazole alone lacks adequate aerobic coverage. If co-amoxiclav is unsuitable because of penicillin allergy, NICE recommends doxycycline combined with metronidazole—not doxycycline alone. Clarithromycin alone is not a recommended alternative. Tetanus immunisation status and the need for vaccination should be assessed separately and do not alter the antibiotic choice.

Reference: National Institute for Health and Care Excellence. Human and animal bites: antimicrobial prescribing, NG184, sections 1.1.11–1.1.12 and Table 1, 2020. https://www.nice.org.uk/guidance/ng184/chapter/Recommendations