Q: Hello, Dr. C. My name is Bill. I am 52 years old and live in Rincon. Recently I was bitten accidentally by my dog, Rufus. He is a generally happy full-grown boxer and is not very aggressive. He was excited when I gave him a piece of scrap meat. When he grabbed for it, he darn near took my thumb with it as part of the snack. It bled a bit. I washed it off and put a bandage on it. The next day, my thumb began to throb so I went to a local ER. They did not put in any stitches, but did give me some antibiotics. It still hurts but is getting better. Should I do anything else?

A. Bill, I know how you feel. Sergei, my Russian wolfhound has on occasion almost included a digit or two of mine in his snacking adventures. Animal bites are a real problem. Dog bites account for 80% of animal wounds. Dogs are taking a real piece out of owners in this country if one considers that the majority of victims do not seek medical attention and probably 300,000 dog bite victims are treated every year in community emergency rooms. As in your case, the victim and the dog are acquainted on a first-name basis. This is important in reaching some decisions regarding care. Dogs, particularly the muscular types such as your boy, Rufus, are capable of causing not only puncture but also crush injuries. Cats, on the other hand, because of their smaller size but very sharp teeth, cause mostly puncture wounds. Dog bites become infected in up to a quarter of cases and the infection is likely what causes most folks to seek medical care just as in your case. Also, as in your case, the infection becomes evident within the first 24 hours after the canine has decided to dine on the digit or elsewhere. The issues to be concerned about include bacterial infection, rabies, tetanus, and wound repair. When infection sets in, the signs and symptoms include redness, pain, swelling, and perhaps pus at the wound site and a fever. Animal bite infections are particularly worrisome in patients who are elderly, have diabetes, liver disease, prosthetic heart valves, or artificial joints as the risk of serious infection is increased. Dog bite infections are usually mixed infections, that is, multiple bacteria may colonize the wound site. Common organisms include Staphylococcus and Streptococcus species (“staph and strep”) and Pasteurella species. The latter bug may cause more rapid infection than the former pair. Regarding antibiotics, it is clear that an antibiotic is called for if there is evidence of an infection. Certainly if there is a deep puncture or crush injury most physicians would prescribe an antibiotic empirically. Antibiotics such as Amoxicillin, Augmentin, Cleocin, and Ceftin are commonly offered. The issue of wound closure (stitches, tapes, etc) is controversial. In general, wounds first seen after 24 hours should not be closed. If seen in less than 8 hours following injury and if there is no evidence of infection, closure may be considered. If the wound is in a region at high risk for infection, such as the hand, it is best to leave the wound open. For facial wounds, consideration for closure and the procedure itself should be done by a plastic surgeon to reduce the risk of late scarring. In an extremity bite, elevation and immobilization are valuable for a successful outcome. The question of rabies vaccinations relates to the immune status of Rufus. Most domestic pets have been vaccinated. The question is an individual one that should involve a public health official. Likewise, the guidelines for tetanus immunization should be followed carefully. Patients treated for bite wounds should be seen in follow-up quickly if the wound continues to become more painful or if the patient becomes generally ill. A routine follow-up in several days is recommended even if healing appears to be progressing uneventfully. Finally, it would be a good idea for you and Rufus to discuss the rules of feeding with an emphasis on the concept, “Don’t bite the hand that feeds you.”