From the Guidelines
For a cat scratch, the most effective treatment to prevent cat scratch disease is azithromycin, with a recommended dose of 500 mg on day 1, followed by 250 mg for 4 additional days for patients weighing ≥45 kg, and 10 mg/kg on day 1, followed by 5 mg/kg for 4 additional days for patients weighing <45 kg, as supported by the Infectious Diseases Society of America guidelines 1.
Initial Wound Care
When dealing with a cat scratch, it's essential to clean the wound immediately with mild soap and warm water for at least 5 minutes to remove bacteria. Applying an antiseptic like hydrogen peroxide or povidone-iodine (Betadine) can further disinfect the area. If the wound is bleeding or in an area prone to dirt exposure, cover it with a clean bandage or adhesive strip.
Preventing Infection
Apply an antibiotic ointment like Neosporin or Polysporin 2-3 times daily for 3-5 days to prevent infection. For pain management, take acetaminophen (Tylenol) or ibuprofen (Advil) as directed. Monitor the wound for signs of infection, including increasing redness, swelling, warmth, pus, red streaks extending from the wound, or fever.
Cat Scratch Disease
Cat scratches can lead to cat scratch disease caused by Bartonella bacteria in cat saliva. If symptoms like swollen lymph nodes, fever, or an infected wound appear, seek medical attention. People with weakened immune systems should be especially vigilant and seek medical care promptly after a cat scratch, as they are at higher risk of developing complications like bacillary angiomatosis 1.
Key Considerations
- Clean the wound immediately and apply antiseptic.
- Use antibiotic ointment to prevent infection.
- Monitor for signs of infection and seek medical attention if necessary.
- Azithromycin is the recommended treatment for cat scratch disease, with specific dosing guidelines based on patient weight 1.
From the FDA Drug Label
Doxycycline is indicated for the treatment of the following infections: ... Bartonellosis due to Bartonella bacilliformis. The answer is: Doxycycline can be used for the treatment of a cat scratch, as it is indicated for the treatment of Bartonellosis, which can be caused by a cat scratch, specifically by Bartonella henselae (not explicitly mentioned but closely related to Bartonella bacilliformis) 2.
- Key points:
- The drug label does not explicitly mention cat scratch disease.
- However, it does mention Bartonellosis, which is related to the disease caused by a cat scratch.
- Doxycycline is indicated for the treatment of Bartonellosis.
From the Research
Treatment Options
- The majority of cases of cat-scratch disease occurring in normal hosts do not require anti-infective therapy for resolution of infection 3.
- Antibiotic therapy is reserved for patients with atypical or severe involvement, including encephalopathy and retinitis 4.
- Azithromycin has been shown to speed recovery in some cases 3, 5.
- Other antibiotics that have been used to treat cat-scratch disease include erythromycin, doxycycline, rifampin, ciprofloxacin, gentamicin, trimethoprim and sulfamethoxazole, clarithromycin 3, 4.
Diagnosis and Clinical Presentation
- Cat-scratch disease is commonly diagnosed in children, but adults can present with it as well 5.
- The disease is usually self-limited and presents as tender lymphadenopathy 5.
- Diagnosis is most often arrived at by obtaining a history of exposure to cats and a serologic test with high titers of immunoglobulin G antibody to B. henselae 5.
- In some cases, cat-scratch disease may present in a more disseminated form with hepatosplenomegaly or meningoencephalitis, or with bacillary angiomatosis in patients with AIDS 5.
Complications and Special Considerations
- Serious complications of B. henselae infections are rare in immunocompetent patients 4.
- Immunocompromised individuals with B. hensalae infection may develop bacillary angiomatosis, bacillary peliosis, and relapsing bacteremia with fever syndrome 3.
- Cat-scratch disease should be included in the differential diagnosis of serious neurologic disease, particularly when regional lymphadenopathy develops suddenly in a previously healthy patient who owns a cat 4.