From the Guidelines
For inpatient treatment of cat bite associated cellulitis, the recommended antibiotic regimen is ampicillin-sulbactam 1.5-3.0 g IV every 6-8 hours or piperacillin-tazobactam 3.37 g IV every 6-8 hours. According to the 2014 practice guidelines for the diagnosis and management of skin and soft tissue infections by the Infectious Diseases Society of America 1, these regimens are recommended for animal bites, including cat bites.
Key Considerations
- Cat bites require coverage for both aerobic and anaerobic bacteria, particularly Pasteurella multocida, which is commonly found in cat bites.
- The chosen antibiotic regimen should provide broad-spectrum coverage against the polymicrobial nature of cat bite infections, including Pasteurella, streptococci, staphylococci, anaerobes, and Capnocytophaga species.
- Treatment duration typically ranges from 5-14 days, depending on the clinical response, with consideration for switching to oral antibiotics once clinical improvement is observed.
Alternative Options
- A combination of ceftriaxone 1-2 g IV daily plus metronidazole 500 mg IV every 8 hours could be considered as an alternative regimen.
- Other options like carbapenems or fluoroquinolones may also be used, but their effectiveness against certain pathogens, such as MRSA, should be taken into account.
Additional Management
- Patients should receive appropriate tetanus prophylaxis if indicated.
- The wound should be thoroughly cleaned, irrigated, and assessed for potential complications such as joint involvement or tendon damage that might require surgical intervention.
From the Research
Antibiotic Regimen for Inpatient Treatment of Cat Bite Associated Cellulitis
The recommended antibiotic regimen for inpatient treatment of cat bite associated cellulitis includes:
- Penicillin as the drug of choice, as it responds well to several antimicrobials 2
- Ampicillin-sulbactam and Clindamycin may also be used, especially in cases of necrotizing fasciitis 3
- Amoxicillin/Clavulanate may be used to treat infections caused by both Pasteurella multocida and anaerobic bacteria, such as Bacteroides pyogenes 4
Considerations for Antibiotic Therapy
When selecting an antibiotic regimen, consider the following:
- The possibility of Pasteurella multocida infection, which is a common cause of cellulitis and other infections following cat bites 2, 5, 6
- The potential for other bacteria, such as Streptococcus, Fusobacterium, and Capnocytophaga, to be present in the wound 6
- The risk of antibiotic resistance, particularly in cases where the patient has been previously exposed to antibiotics or has a history of resistant infections 4
Importance of Surgical Drainage and Culture
Surgical drainage and culture of the wound are crucial in the treatment of cat bite associated cellulitis, as they can help to: