From the Guidelines
For cat scratch treatment, the primary approach should be to clean the wound immediately with mild soap and water, followed by the application of an antiseptic and an antibiotic ointment, with the consideration of oral antibiotics like azithromycin for certain cases as recommended by guidelines 1. When managing a cat scratch, it's crucial to prioritize wound cleaning and monitoring for signs of infection. The wound should be cleaned with mild soap and water for 5 minutes, then an antiseptic such as hydrogen peroxide or povidone-iodine (Betadine) can be applied. After cleaning, applying an antibiotic ointment like Neosporin or Polysporin and covering with a clean bandage is advisable. The bandage should be changed daily, and the wound should be monitored for signs of infection, including increasing redness, swelling, warmth, pus, or red streaks extending from the wound. For patients who develop cat scratch disease, particularly those with symptoms or at high risk, azithromycin is recommended 1, with dosing protocols as follows:
- Patients >45 kg: 500 mg on day 1 followed by 250 mg for 4 additional days.
- Patients <45 kg: 10 mg/kg on day 1 and 5 mg/kg for 4 more days. Given the potential for cat scratches to lead to cat scratch disease caused by Bartonella bacteria, prompt and thorough wound care is essential to prevent infection. Individuals with weakened immune systems should be particularly cautious and consider consulting a healthcare provider even for minor scratches.
From the FDA Drug Label
Directions adults and children 2 years of age and older: clean the affected area apply a small amount of this product (an amount equal to the surface area of the tip of a finger) on the area 1 to 3 times daily may be covered with a sterile bandage children under 2 years of age: ask a doctor For topical treatment of a cat scratch, bacitracin can be applied to the affected area. The recommended application is:
- Clean the affected area
- Apply a small amount of bacitracin (about the size of the tip of a finger)
- Apply 1 to 3 times daily
- May be covered with a sterile bandage For children under 2 years of age, it is recommended to ask a doctor 2
From the Research
Topical Treatment for Cat Scratch
- There are no specific studies on topical treatments for cat scratch disease caused by Bartonella infections [ 3, 4, 5, 6, 7 ].
- However, the studies suggest that antibiotics such as azithromycin, doxycycline, gentamicin, and erythromycin may be effective in treating Bartonella infections [ 3, 4, 5, 6, 7 ].
- It is essential to note that the effectiveness of these antibiotics may vary depending on the severity and type of infection, as well as the patient's immune status [ 5, 7 ].
Antibiotic Susceptibility
- The Etest has been used to assess the in-vitro susceptibility of Bartonella henselae to various antibiotics, including erythromycin, azithromycin, doxycycline, ciprofloxacin, rifampicin, and vancomycin [ 6 ].
- The results showed that B. henselae is highly susceptible to erythromycin, azithromycin, doxycycline, and rifampicin, but less susceptible to ciprofloxacin and resistant to vancomycin [ 6 ].
- Another study identified several FDA-approved drugs with activity against stationary phase B. henselae, including pyrvinium pamoate, daptomycin, methylene blue, and aminoglycosides [ 4 ].
Treatment Outcomes
- A systematic review and meta-analysis found that antibiotics did not significantly affect the cure rate or time to achieve cure in patients with cat scratch disease [ 5 ].
- However, gentamicin and doxycycline were found to significantly increase the resolution rate in patients with chronic bacteremia [ 5 ].
- The recommended treatment for Bartonella infections varies depending on the type and severity of the infection, as well as the patient's immune status [ 7 ].