From the Guidelines
For superficial cat scratches, antibiotic prophylaxis is not recommended as the primary treatment. The current guidelines from the Infectious Diseases Society of America, as outlined in the 2014 update 1, suggest that the use of antimicrobial agents in the treatment of cat scratch disease has had variable results. The recommended approach for managing superficial cat scratches involves proper wound care, including thorough cleaning with soap and water, application of an antiseptic, and covering with a clean bandage if necessary.
Key considerations in managing superficial cat scratches include:
- Monitoring the scratches for signs of infection, such as increasing redness, swelling, warmth, pain, or pus formation
- Seeking medical attention if signs of infection develop or if the individual has a compromised immune system
- Being aware of the potential for cat scratch disease, caused by Bartonella henselae bacteria, which typically presents with lymph node swelling near the scratch site 1-3 weeks after injury
According to the guidelines 1, azithromycin may be considered for the treatment of cat scratch disease, with a recommended dose of 500 mg on day 1, followed by 250 mg once daily for 4 additional days for patients weighing ≥45.5 kg. However, this is not recommended as prophylaxis for superficial scratches but rather as treatment for confirmed or suspected cat scratch disease. Preventive measures, such as avoiding rough play with cats and washing hands after handling them, are also important in reducing the risk of infection.
From the Research
Antibiotic Prophylaxis for Superficial Cat Scratches
- The majority of cases of cat-scratch disease occurring in normal hosts do not require anti-infective therapy for resolution of infection 2.
- Cat-scratch disease is usually a self-limited illness that does not necessarily require antibiotic therapy 3.
- However, antibiotic prophylaxis should be considered for high-risk wounds, such as cat bites, puncture wounds, or wounds to the hand, especially in immunosuppressed individuals 4.
- For cat scratches, the risk of infection is generally lower than for cat bites, but antibiotic prophylaxis may still be considered in certain cases, such as deep or puncture wounds, or in immunocompromised patients.
Specific Antibiotics for Cat Scratches
- Azithromycin, clarithromycin, and other antibiotics have been shown to be effective in treating cat-scratch disease 2, 3.
- Amoxicillin/clavulanate is a commonly recommended antibiotic for prophylaxis in animal bites, including cat bites 4, 5.
- The choice of antibiotic should cover beta-lactamase-producing aerobic and anaerobic organisms, including Pasteurella species in animal bites 5.
Management of Cat Scratches
- Cleaning and irrigation of the wound are essential in preventing infection 4, 5.
- Wounds may be closed if cosmetically favorable, but primary closure should be considered only for bites in which the concerns about cosmetic outcome outweigh the risk of infection 4, 5.
- Patients with cat scratches should be monitored for signs of infection and treated promptly if infection occurs.