Is the management of dog bite wounds evidence based? A postal survey and review of the literature.

OBJECTIVES: To determine current practice in the management of dog bite wounds with regard to the use of prophylactic antibiotics and primary closure and to compare the available evidence. METHODS: We conducted a national postal survey of Accident and Emergency (A and E) departments in the UK to ascertain the current practice in the management of recent dog bite wounds. A questionnaire was designed and posted to a named A and E consultant. Non-respondents were sent a single reminder 8 weeks after the initial mailing. A detailed literature search was carried out using Medline, Embase and Cochrane databases to look at the available evidence. RESULTS: The postal survey yielded an 80% response. Prophylactic antibiotics were routinely used by 53% of the respondents. Although 99% of the respondents were happy to close facial dog bite lacerations, 60% were reluctant to suture other body regions. Recent available evidence suggests that restricting the use of prophylactic antibiotics for high-risk dog bite wounds and the primary suturing of appropriate dog bite lacerations is safe. CONCLUSIONS: The management of recent dog bite wounds is not entirely evidence based in many A and E departments in the UK.