Dose is calculated using the amoxicillin component.
Max 875 mg/dose (amoxicillin) · Max 1750 mg/day · Duration: 3–5 days · Prophylaxis: 3–5 days (Children's Mercy 3 days; CHOP/AAFP 3–5 days) — extend to 5–10 days if established infection without hospitalization
• Prophylactic antibiotics NOT needed: bites that did not break skin, trivial superficial abrasions, or low-risk dog bites in reliable follow-up per shared decision-making (AAFP, CHOP — routine prophylaxis for all bites is controversial).
• Therapeutic antibiotics (5–10 days): established infection — cellulitis, purulence, lymphangitis, fever — reassess at 48 h; culture wound when infected (IDSA SSTI, CHOP, Children's Mercy 7 days treatment).
• High-dose amoxicillin/clavulanate (45 mg/kg/dose amox BID): facial bites with sinus penetration concern — Children's Mercy optional escalation; standard 22.5 mg/kg/dose adequate for most dog/cat bites.
• Hospitalize with IV ampicillin/sulbactam if systemic toxicity, unable to tolerate oral therapy, deep space infection, or concern for tenosynovitis/osteomyelitis — use hospitalized variant (Stanford, CHOP).
• IV ampicillin/sulbactam when: hospitalized with established bite infection, systemic toxicity, unable to tolerate oral therapy, failed outpatient oral therapy at 48 h, or deep tissue infection suspected (Stanford, CHOP, IDSA).
• Covers Pasteurella, Capnocytophaga, streptococci, MSSA, H. influenzae, and anaerobes — equivalent to IV amoxicillin/clavulanate (AAP Red Book, Children's Mercy).
• Obtain wound culture before antibiotics when feasible — blood cultures if systemically unwell (CHOP, IDSA).
• Add MRSA coverage (vancomycin or clindamycin) if purulent MRSA risk, severe infection, or culture confirmation — CPS/local epidemiology (IDSA SSTI).
• Orthopedic/hand surgery consultation for tendon, joint, or bone involvement; IR drainage if abscess (AAFP, CHOP).
Enter weight on Kids to calculate doses
Clindamycin • p.o. • 10–10 mg/kg/dose • 3×/day
Max 600 mg/dose · Max 1800 mg/day · Duration: 3–10 days · Must combine with TMP/SMX or doxycycline (≥8 years) for Pasteurella/Capnocytophaga — clindamycin alone insufficient
• Penicillin/amoxicillin true allergy: dual therapy required — clindamycin PLUS TMP/SMX (or doxycycline ≥8 years), OR metronidazole PLUS TMP/SMX/doxycycline — single-agent alternatives inadequate for bite flora (Children's Mercy, AAP Red Book).
• Re-evaluate at 48 h for all prophylaxis cases — escalate to therapeutic duration (5–10 days) or IV therapy if infection develops (CHOP, AAFP).
• Wound culture when infected — tailor therapy to susceptibilities; ID consult for deep infection, bone/joint involvement, or immunocompromise (CHOP, Children's Mercy).
• Rabies PEP and tetanus are separate from antibiotic choice — assess for every bite breaking skin (AAP, WHO, CDC).
• Primary wound closure may be performed for low-infection-risk facial dog bites after irrigation — avoid closure of high-risk hand/cat puncture wounds (AAFP, IDSA principles).
• Oral step-down: switch to amoxicillin/clavulanate when clinically improving after 24–48 h IV therapy — complete 5–10 days total for cellulitis (CHOP, Stanford).
• Rabies PEP: administer per exposure regardless of antibiotic therapy — do not delay wound care or rabies biologics for antibiotics (CDC, WHO, AAP).
• Capnocytophaga risk: asplenic or immunocompromised patients bitten by dogs/cats — lower threshold for admission, IV therapy, and prolonged monitoring (AAP Red Book).
Dose is calculated using the trimethoprim component.
Max 160 mg/dose (trimethoprim) · Max 320 mg/day · Duration: 3–10 days · TMP component — second agent with clindamycin for penicillin allergy (Children's Mercy)
Enter weight on Kids to calculate doses
Clinical notes
• Prophylactic antibiotics: high-risk bites only — cat punctures, hand/face/genital, deep/puncture, immunocompromise, crush injury; amoxicillin/clavulanate 3–5 days (CHOP, Children's Mercy, AAFP); not needed if skin not broken.
• Therapeutic antibiotics: established cellulitis/abscess/lymphangitis — amoxicillin/clavulanate 5–10 days (7 days Children's Mercy; 10–14 days if extensive cellulitis per Stanford); culture directed therapy when possible.
• Wound management: copious irrigation with saline or clean water, remove foreign bodies and devitalized tissue, document neurovascular status and joint function, tetanus risk assessment, consider imaging if foreign body or bone involvement (AAFP, IDSA, NICE NG53 human/animal bites principles).
• Tetanus prophylaxis: assess vaccination status — give Tdap/Td if indicated; tetanus immune globulin (TIG) for incomplete primary series with tetanus-prone wound per immunization schedule (AAP Red Book, WHO wound management).
• Rabies PEP (mammal bites breaking skin): thorough wound wash with soap/water; for previously unvaccinated — rabies vaccine IM days 0, 3, 7, 14 (± day 28 if immunocompromised) plus HRIG 20 IU/kg infiltrated in/around wound (remainder IM distant from vaccine); consult public health — PEP may stop if animal proven non-rabid (CDC, WHO Category II–III, AAP Red Book).
• AAP Red Book — Bite wounds (dog, cat, other animals) (2024)
