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Bitten by dog. Taking anti-rabies injections. Swelling, pus and red. Washing wound with hydrogen peroxide and applying Neosporin. Novamx?

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General Surgeon
Practicing since : 2008
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My wife got bitten by a dog 4 days ago. She is taking anti-rabies injections but her wound is not healing. Should I give her any antibiotic like Novamx (Amoxycillin)? She took 2 anti-rabies injections (Rabipur) till now. That dog got anti-rabies injections from govt long back. Her wound is having swelling, pus and red areas near by. I am washing her wound with hydrogen peroxide and applying Neosporin.
Posted Sat, 27 Jul 2013 in General Health
Answered by Dr. Grzegorz Stanko 57 minutes later

Thank you for the query.

Dog bite wound usually heals really bad. This is because there is a plenty of bacteria in a dog mouth. Due to bite, this bacteria (which are usually unknown for human body) cause soft tissues infection. Such infection can cause muscles swelling. Swollen muscle starts getting compressed because there is no space for enlarged (swollen) muscle. Such process can lead to necrosis of a muscle and surrounding tissues.
Pus and redness indicates serious inflammation which wont go away without medical attention. Amoxycillin is not the best choice.

I suggest your wife to visit general surgeon right away. The wound might need an incision to make more space for swollen tissues. Swab test needs to be done and strong antibiotic prescribed (like Clindamicine).

Hope this will help. Feel free to ask further questions.
Above answer was peer-reviewed by
Follow-up: Bitten by dog. Taking anti-rabies injections. Swelling, pus and red. Washing wound with hydrogen peroxide and applying Neosporin. Novamx? 9 hours later
Thanks for your reply.

Let me summarise the case, before asking some questions:

My wife was bitten by a stay dog on 5th July morning, that dog got anti-rabies injections form government according to the locals of that area. We went to a hospital in evening but doctor injected only tetanus stating since jeans is not torn so no need of anything else (but even blood came out). A day after we went to another doctor who asked to take rabies immunoglobulin injections along with anti-rabies injections. Then we started anti-rabies injection from 6th July noon and till now she got two ant-rabies injections; day 0 and 3.
Since that dog is fine till now and got anti-rabies injections, so we skipped rabies immunoglobulin injections to her since those very costly and out of our budget.
Till yesterday night her wound was not healing and having pus and swelling near by but after washing her wound with hydrogen peroxide and applying Neosporin, till morning swelling is reduced.

I took advice from two very good doctors and both are suggesting differently.
I can go for rabies immunoglobulin in case needed even if it requires borrowing some money from my boss :(

Her wound seems to be healing now and I think tetanus injection was helpful along with the current application of hydrogen peroxide & Neosporin.

I am not able to upload her wound pic in this portal, otherwise that will be helpful for you to decide.
Her wound size is less then 1 inches and seems to be 3-4 mm deep. Now swelling is reduced from 3 inches circle to 1.5 inches circle from yesterday night.

Your suggestions over the followings will be very helpful for her:
1- Should we go for rabies immunoglobulin now?
2- How many anti-rabies injections we should take?
3- Since hydrogen peroxide & Neosporin treatment is reducing swelling, so should we go for antibiotic & surgeon?
4- Should we now consult any other doctor or can go ahead with current treatment?

Answered by Dr. Grzegorz Stanko 15 hours later
1. Dog observation should take 15 days (starting from the bite day). During that time, you can not say if the dog were infected with rabies or not. So it seems to be reasonable to have another two shots in 7 and 14 day.

However, if the dog was vaccinated in the last year, no vaccination is necessary.

2. 2 more shots should be taken. It will take 14 days. This is the time the dog should be under observation. If after 15 days the dog will be fine, no more vaccination is necessary.
3. If the swelling goes away, surrounding tissues are not painful, hard and tensed, you may assume that the wound is getting better and will heal by its own. However if it will start getting worse, the pain, hardness, tensed skin will appear, you should visit general surgeon.
4.If she is improving, no new symptoms, you should continue with advised treatment.

Please note that wound infection is not caused by rabies or tetanus. Both viruses can cause neurological symptoms and serious complication, however wound condition has nothing to do with this viruses. Wound is infected by bacteria from the dogs mouth.

Hope this will help.
Above answer was peer-reviewed by
Follow-up: Bitten by dog. Taking anti-rabies injections. Swelling, pus and red. Washing wound with hydrogen peroxide and applying Neosporin. Novamx? 18 hours later
Thanks Dr. Stanko, your answers are very helpful for us.

I have only few doubts left
1- Now we need not to give rabies immunoglobulin injections since she is taking anti-rabies injections?
2- What is the difference between rabies immunoglobulin and anti-rabies injections?
if both are same then both should not be given at the same time?
3- If that dog dies then we will go ahead with complete 5 injections course of anti-rabies otherwise will be stopping at 4.
4- If that dog dies then we should also go for rabies immunoglobulin?

Answered by Dr. Grzegorz Stanko 5 hours later
1. Immunoglobulin should be given in dog bite day. It is given as a single shot. Guidelines say that rabies immunoglobulin should be given in case of deep bite and wound contact with the saliva. Right now, there is no point to give immunoglobulin.

2. Rabies vaccination (anti-rabies shots) contain dead rabies virus. Its task is to stimulate your immune system to recognize rabies virus and kill it instantly. This is quite complicated process. When human immune system does not know some virus or bacteria, it needs a time to prepare for an infection. During this preparing time, lymphocytes are learning to produce specific antibodies (immunoglobulins). Moreover, such learned lymphocytes remain in lymph nodes for many years or for the rest of the life, waiting for same virus. In case of second infection, the virus wont be able to cause symptoms as it will be killed right away.
Giving immunoglobulin injections, we get this specific immunoglobulins right away so the virus can be killed right away. It gives us an ability to substitute immune system for some time.
This immunoglobulins are produced by someone else and extracted from his blood. So we can say that immunoglobulin works instantly, rabies vaccinations needs time to take an effect.
3. Yes, if the dog dies, all 5 dosages should be taken. If it will survive, 5th dosage is not necessary, however it is good to finish full course to be protected in the future. But as you have mentioned that it is expensive, it is not extremely necessary in case of healthy dog.
4. Its too late for rabies immunoglobulin as it should be given right away after the bite.

Hope this will help.
Above answer was peer-reviewed by
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