What is the treatment for infected cat bites using Ceftriaxone (Rocephin) and Amoxicillin-Clavulanic acid (Amoxicillin-Clavulanate)?

From the Guidelines

For infected cat bites, a combination of Rocephin (ceftriaxone) as initial treatment followed by oral Amoxicillin-Clavulanate is an effective approach. Typically, Rocephin 1-2g IV or IM is administered as a single dose in the emergency department or urgent care setting, followed by oral Amoxicillin-Clavulanate (commonly 875mg/125mg) twice daily for 5-7 days. This regimen targets the polymicrobial nature of cat bite infections, which often contain both aerobic bacteria (like Pasteurella multocida) and anaerobes. Pasteurella, the most common pathogen in cat bites, is particularly sensitive to this combination, as noted in the guidelines by the Infectious Diseases Society of America 1.

The initial Rocephin provides rapid, broad-spectrum coverage while the Amoxicillin-Clavulanate continues treatment with good oral bioavailability. Key considerations for choosing this regimen include its effectiveness against the common pathogens found in cat bites, including Pasteurella multocida, as well as its coverage of anaerobic bacteria, which are frequently present in these infections 1.

In addition to antibiotics, proper wound care is essential:

• Thoroughly clean the wound
• Consider leaving puncture wounds open to heal by secondary intention
• Monitor for signs of worsening infection such as increasing redness, swelling, pain, or fever. Patients with severe infections, immunocompromised status, or bites to high-risk areas like joints or tendons may require longer treatment courses or hospitalization for IV antibiotics, as outlined in the practice guidelines for the diagnosis and management of skin and soft tissue infections 1.

It's also important to note that some antibiotics, such as first-generation cephalosporins and macrolides, have poor activity against Pasteurella multocida and should be avoided in the treatment of cat bites, as recommended by the guidelines 1. The choice of antibiotic should be guided by the most recent and highest quality evidence available, prioritizing the effectiveness of the treatment against the common pathogens involved in cat bite infections, while also considering the potential for resistance and the need for anaerobic coverage.

From the FDA Drug Label

To reduce the development of drug-resistant bacteria and maintain the effectiveness of Ceftriaxone for Injection and other antibacterial drugs, Ceftriaxone for Injection should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria SKIN AND SKIN STRUCTURE INFECTIONS Caused by Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pyogenes, Viridans group streptococci, Escherichia coli, Enterobacter cloacae, Klebsiella oxytoca, Klebsiella pneumoniae, Proteus mirabilis, Morganella morganii,1Pseudomonas aeruginosa, Serratia marcescens, Acinetobacter calcoaceticus, Bacteroides fragilis1or Peptostreptococcus species

1. Indications and Usage To reduce the development of drug-resistant bacteria and maintain the effectiveness of amoxicillin and clavulanate potassium tablets USP, and other antibacterial drugs, amoxicillin and clavulanate potassium should be used only to treat infections that are proven or strongly suspected to be caused by susceptible bacteria 1.4 Skin and Skin Structure Infections – caused by beta-lactamase–producing isolates of Staphylococcus aureus, Escherichia coli, and Klebsiella species.

The treatment of infected cat bites may involve Ceftriaxone (IV) and Amoxicillin-Clavulanate (PO), as both drugs have indications for skin and skin structure infections.

• Ceftriaxone is effective against a range of bacteria, including Staphylococcus aureus, Streptococcus pyogenes, and Escherichia coli.
• Amoxicillin-Clavulanate is effective against beta-lactamase–producing isolates of Staphylococcus aureus, Escherichia coli, and Klebsiella species. However, the choice of antibiotic should be guided by susceptibility testing and local epidemiology 2 3.

From the Research

Treatment of Infected Cat Bites

• The treatment of infected cat bites often involves the use of antibiotics, with Amoxicillin-Clavulanate being a recommended option 4.
• Rocephin (Ceftriaxone) is a cephalosporin antibiotic that may be used in some cases, but its effectiveness against cat bite infections is not specifically mentioned in the provided studies.
• Amoxicillin-Clavulanate is effective against a wide range of bacteria, including Pasteurella multocida, which is commonly found in cat bite wounds 4, 5.
• The use of Amoxicillin-Clavulanate has been shown to be effective in treating urinary tract infections caused by ceftriaxone non-susceptible Enterobacterales 6.

Guidelines for Treatment

• The management of cat and dog bites should include an assessment of the risk of infection and the need for tetanus immunization 4.
• Patients who present with symptoms of tissue infection due to a cat or dog bite should be examined adequately and may need admission 7.
• Amoxicillin-Clavulanate is often used as empiric therapy for many infections, but its use should be guided by epidemiological and pharmacokinetic data 5.

Antibiotic Options

• Amoxicillin-Clavulanate is a widely used antibiotic combination that has been shown to be effective against a range of bacterial infections 5, 8.
• Cephalosporins, such as cefdinir and cefpodoxime, are also effective against certain bacterial infections, but their use may be limited by resistance patterns 8.
• The choice of antibiotic should be guided by the suspected or confirmed causative organism and local resistance patterns.