Dog and cat bites

How common are cat and dog bites?

Dog bites are the most common type of animal bite. When people attend A&E departments with bites, between 6 and 9 out of 10 of them have dog bites.

Cat bites are less common. Around 5-20 out of every 100 people attending A&E with a bite have been bitten by a cat.

In the UK about 250,000 people each year go to an emergency department because they have been bitten by a dog. Probably many more bites occur but people do not see a doctor about them, so it is hard to be sure. In the USA, 4.5 million people are thought to be bitten by a dog every year, with 885,000 seeking medical attention. The World Health Organization (WHO) estimates that globally tens of millions of people are bitten by dogs each year.

Who is at risk?

Bites are caused most often by the owner's own pet or an animal known to them. Boys get bitten more than girls. Children are most commonly affected. Children are more likely to be bitten on the head or neck and are therefore more likely to have the more serious bites. Severe dog bites occur most often in children under the age of 5 years.

Some dogs are more dangerous than others. Those thought to be most dangerous include rottweilers, pit bull terriers, and German shepherd dogs, but even small dogs can inflict serious bites. Some that can cause the worst injury, such as pit bull terriers, are illegal to own in the UK.

Many animal bites are unprovoked. However, animals are more likely to bite if they are frightened, suddenly disturbed, or feel threatened.

What should I do?

You should clean the wound no matter how small the cut to the skin. There are many germs (bacteria) in animal mouths. Cleaning will reduce the chance of infection. If the wound is small, you can clean it yourself. Just use ordinary tap water. Let it bleed freely, unless the bleeding is very heavy. If the wound is bleeding heavily, use a clean pad, or preferably a sterile dressing, to apply pressure until you can get medical treatment. Wounds that are large, deep, punctured or dirty are best cleaned and assessed by a nurse or doctor.

After cleaning, cover the wound with a sterile, non-sticky dressing. Consider going to see your doctor, or attending A&E.

When should I see a health professional following a cat or dog bite?

Unless it is a very trivial bite, it is wise to seek medical advice. If the wound is bleeding heavily, attend an accident and emergency (A&E) or minor injuries unit. Also attend A&E if the bite is on an ear, nose or face, or if a child has been bitten on the head. For other bites, see your GP. See a doctor for any cat bite, as these are particularly likely to become infected.

In countries where rabies is a risk, see a doctor for even a trivial bite. If your tetanus jabs aren't up to date, see a health professional to have a booster.

In particular, get the bite assessed if:

• The bleeding is heavy (go to A&E if you can't stop the bleeding).

• The wound is wide or deep.

• The bite is on the head of a small child (go to A&E).

• The bite is on your face, ears, hands, genitals or over joints.

• There is a possibility the dog or cat has rabies. (This is not a risk if the bite happened in the UK.)

• You have not had a complete course of tetanus immunisation, or if your booster is due.

• The skin around the bite has become red or hot, or if the wound is oozing.

• You develop a high temperature (fever) after a bite.

• Your immune system is not working properly (for example, because you do not have a spleen, due to medication, chemotherapy or AIDS).

• You have an artificial heart valve or a replaced joint.

When should I go to an A&E department with a cat or dog bite?

In some situations you may need specialist or urgent treatment and should go directly to your nearest A&E. For example, if:

• The bleeding from the wound does not stop.

• The bite is on the head of a child.

• The bite is more than skin-deep - for example, if you can see bone or tendon in the wound.

• There is a 'foreign body' in the wound - for example, a part of the animal's tooth.

What treatment might I need from a doctor or hospital?

Wound care

The wound can be properly assessed and cleaned. If part of the wound has dead or damaged skin then this may need to be trimmed or removed. This is because infection is more likely to develop in dead skin. So, if in doubt, see a doctor or go to your local A&E department.

Do not be surprised if the doctor does not stitch or close up a dog or cat wound immediately. For many bites it is safer to let them heal on their own. For some bites in some parts of the body it is common practice to wait for a few days before closing the wound. This is particularly the case if the wound is more than six hours old. This is to make sure the wound is not infected before closing it up. A wound that becomes infected after it has been stitched or closed up, can cause serious complications. After the wound is cleaned (and trimmed of dead or damaged tissue, where necessary), a sterile dressing is normally applied.

Large, severe or deep bites may require an operation to clean the wound and repair underlying structures that may be damaged, such as tendons.

Antibiotic medicines

Guidelines recommend that we do not offer antibiotics to people with animal bites that have not broken the skin.

If the bite has broken the skin but not drawn blood, antibiotics will be offered if it involves a high-risk area such as the hands, feet, face, genitals, skin over joints or an area of poor circulation. They will also be offered if you are at higher risk of a serious wound infection because of a medical condition, such as having:

• Diabetes.

• A poorly acting immune system.

• No spleen.

• Significant liver disease.

Offer antibiotic prophylaxis to people with a bite from cats or dogs which has broken the skin and drawn blood if it:

• Has penetrated bones, joints, tendons or blood vessels.

• Is deep, is a puncture or crush wound, or has caused significant tissue damage.

• Is visibly contaminated (for example, if there is dirt or a tooth in the wound).

Antibiotics will be prescribed if the bite has broken the skin and drawn blood, and if it is thought the wound has already started to become infected.

The first-choice antibiotic for an adult with an animal bite is co-amoxiclav - also called Augmentin. If you are allergic to penicillin you will be given doxycycline and metronidazole. If you already have an infection you will need to take it for five days but this can be increased to seven days if there is significant tissue damage or the bite has gone into bone, joints or blood vessels. If you are prescribed antibiotics with a view to preventing infection, three days of treatment should be enough.

If a child has a bite there is an alternative first-choice antibiotic called co-trimoxazole, but the other antibiotics used are the same.

Antibiotics will also be prescribed if your wound has already become infected. It might be infected if:

• It is getting more painful rather than improving as time goes by.

• It has become red or swollen.

• It is oozing.

Tetanus

Check that you are up to date with your tetanus immunisations. If you're not, you may require a booster dose.

Rabies

Rabies is a very serious illness passed to humans from some animal bites. At present the UK is free from rabies. However, animal bites (particularly dog bites) that occur abroad have a risk of rabies. When abroad, take seriously even the tiniest of dog bites, or a lick from a dog over a cut or wound. If needed, treatment straight after a bite can prevent rabies from developing. It is important that the treatment should be given quickly, so see a doctor as soon as possible.

What are the possible complications?

Infection is common after dog and cat bites. Infection can be in or around the wound, causing redness or swelling. Or it may spread away from the original bite, to affect more areas of skin (cellulitis), or tissue nearby such as bone (osteomyelitis) or through the bloodstream to other parts of the body. Rarely, this can go on to cause infections of the brain (meningitis or encephalitis), or the heart (endocarditis), or throughout the body (sepsis).

In some countries where some animals have rabies, this is a risk after a bite from an unknown animal. Dogs are the most common carriers of the rabies infection.

Rarely, other infections, such as tetanus or cat scratch disease can be complications.

On a more psychological level, animal bites can leave people with a phobia about that particular animal.

Rarely, animal bites can be fatal. This may occur if the bite involves a vital blood vessel and a lot of blood is lost. It may occur if there is widespread infection as mentioned above. It is a particular risk in small infants, whose skulls are soft, if they have a severe bite on the head. Of course the majority of bites are much more trivial than this.

What should I look out for after a dog or cat bite?

The most common complication following a bite is an infection of the wound. See a doctor as soon as possible if the skin surrounding a wound becomes more tender, painful, swollen, or inflamed over the following few days. Rarely, some germs (bacteria) can get into the bloodstream through a wound and cause a serious infection in the body. See a doctor urgently if you become generally unwell with a high temperature (fever), shivers, or other worrying symptoms within a week or so after a dog or cat bite.

Some people, particularly children, may become scared of dogs if they have been bitten. They may get nightmares, or become worried. To try to stop this, talk to them about what happened, and why, and help them learn to interact with pets safely. If they are still having problems, see a doctor.

If I own a cat or dog, what steps can I take to prevent bites?

Cats and dogs should be 'socialised' early. That is, if you have a new puppy or kitten in your home, get them used to people, so they do not find strangers scary. Visit the vet regularly for check-ups and vaccinations for your pet, so they keep healthy. Dogs should be trained early, which helps them be more confident and less likely to bite as a result of being scared.

Never leave young children alone with a cat or dog. Teach your children how to handle pets safely and in a way which your pet enjoys rather than finds unpleasant or scary. Teach them not to disturb a pet who is sleeping and how to handle animals gently and kindly.

What else can I do to avoid being bitten by a cat or dog?

Avoid patting or stroking a dog or cat who doesn't know you. Check with the owner that their pet likes this before doing so. Be very wary around stray dogs or cats, particularly if they look ill or neglected. Do not approach stray animals in countries where rabies is a risk. Avoid approaching animals that look aggressive. For example, cats who are hissing or who have the fur on their tail sticking up, or dogs that are snarling or baring their teeth. Avoid approaching dogs that have puppies, or cats that have kittens, as they may bite if they fear their young are at risk from a stranger.

Try to avoid running from a dog, as their natural instinct may be to chase you. Stay still and keep calm if approached by an unfamiliar dog.