From the Guidelines
For a cat scratch skin infection, the most effective treatment is azithromycin, with a recommended dose of 500 mg on day 1, followed by 250 mg for 4 additional days for patients weighing ≥45.5 kg, and 10 mg/kg on day 1, then 5 mg/kg for 4 more days for those weighing <45.5 kg, as supported by the Infectious Diseases Society of America guidelines 1.
Initial Wound Care
When dealing with a cat scratch skin infection, it's crucial to start with proper wound care. This includes cleaning the wound immediately with soap and water, then applying an antiseptic like hydrogen peroxide or povidone-iodine. The wound should be covered with a sterile bandage and changed daily to prevent further infection.
Monitoring for Infection
It's essential to watch for signs of worsening infection, such as increasing redness, swelling, warmth, pus, or red streaks extending from the wound. If these symptoms occur, one should see a healthcare provider promptly, as oral antibiotics may be necessary.
Antibiotic Treatment
For cat scratch disease, which is caused by Bartonella bacteria in cat saliva, specific antibiotic treatment is typically required. Azithromycin is the most commonly recommended antibiotic for this condition, with the dosing protocol as mentioned earlier. People with weakened immune systems should be especially vigilant about seeking medical care for cat scratches, as they are at a higher risk of developing more severe infections.
Key Considerations
- The diagnosis of Bartonella infections can be challenging due to the fastidious nature of the organism and cross-reactivity with other organisms in serological tests 1.
- A positive Warthin-Starry silver stain of infected lymph node tissue can be useful to confirm the diagnosis, although it cannot differentiate species of Bartonella 1.
- Treatment with antimicrobial agents has shown variable results, but azithromycin has been found to reduce lymph node size significantly in some studies 1.
From the Research
Treatment for Cat Scratch Skin Infection
The treatment for cat scratch skin infection, also known as cat-scratch disease, depends on the severity of the infection.
- For uncomplicated cases, the disease is usually self-limited and does not require antibiotic therapy 2, 3, 4.
- However, for severe or persistent cases, several antibiotics have been shown to be effective, including:
- Erythromycin and doxycycline 2
- Rifampin, ciprofloxacin, gentamicin, trimethoprim and sulfamethoxazole, clarithromycin, and azithromycin 3
- Ciprofloxacin has been reported to be effective in treating cat-scratch disease in adults 5
- Gentamicin has been shown to be effective in shortening the course of the disease 6
- Azithromycin has been shown to speed recovery in one small study 4
Antibiotic Therapy
Antibiotic therapy is usually reserved for patients with atypical or severe involvement, including encephalopathy and retinitis 2.