From the Guidelines
If you've been bitten or scratched by an unvaccinated cat, immediately clean the wound thoroughly with soap and running water for at least 5 minutes, then apply an antiseptic like povidone-iodine or hydrogen peroxide, and seek medical attention promptly to prevent serious infections. The treatment for unvaccinated cat bites/scratches should prioritize wound cleaning and assessment for potential infections, including rabies. According to the guidelines from 1, wound cleansing is crucial in preventing rabies, and immediate gentle irrigation with water or a dilute water povidone-iodine solution can decrease the risk of bacterial infection.
Key Considerations
- The risk of rabies transmission should be assessed, and post-exposure prophylaxis (PEP) considered based on the cat's behavior and local rabies prevalence, as recommended by 1 and 1.
- A healthcare provider may prescribe antibiotics, such as amoxicillin-clavulanate (Augmentin), to prevent infection, especially if the wound is deep or there is a high risk of infection, as suggested by the guidelines from 1.
- For patients with cat scratch disease, azithromycin may be prescribed, as it has shown some efficacy in reducing lymph node size, according to the study by 1.
- Tetanus booster shots may be recommended for deeper wounds if the patient's tetanus vaccination is not up to date.
Infection Prevention and Monitoring
- Cat bites and scratches can lead to serious infections, including those caused by Pasteurella multocida and Bartonella henselae, as noted in the study by 1.
- Patients should monitor their wounds for signs of infection, such as increasing redness, swelling, warmth, pain, or pus, and seek immediate medical care if these symptoms develop.
- The use of antibiotic prophylaxis and primary wound closure should be individualized based on the exposing animal species, size and location of the wound, and time interval since the bite, as recommended by 1.
From the Research
Treatment for Unvaccinated Cat Bites/Scratches
- The primary concern with unvaccinated cat bites/scratches is the risk of rabies transmission, as rabid animals are the only source of infection 2.
- The virus is shed in the saliva some days before the onset of clinical signs and can be transmitted through a bite or a scratch to the skin or mucous membranes 2.
- Post-exposure vaccination of cats depends on national public health regulations, and is forbidden in many countries 2.
- For humans, post-exposure prophylaxis (PEP) is crucial in preventing rabies, and the vaccine can prevent 99% of deaths if administered promptly after exposure 3.
- PEP typically includes wound washing and antisepsis, a series of intradermal (ID) or intramuscular (IM) rabies vaccinations, and rabies immunoglobulin in WHO category III exposures 4.
- Abridged vaccination schedules, such as the 1-week, 2-site ID PEP schedule, have been found to be safe, immunogenic, and cost-effective 4.
- It is essential to carefully clean and disinfect all bite injuries, and antibiotic treatment may be necessary to prevent bacterial infections, particularly in deep wounds caused by cats 5.
- In some cases, rabies transmission through cat scratches has been reported, even with intra-dermal postexposure prophylaxis 6.