From the Guidelines
Amoxicillin-clavulanate (Augmentin) is the best first-line antibiotic for cat bite infections, typically prescribed at 875/125 mg twice daily for adults for 5-7 days. This recommendation is based on the most recent and highest quality study available, which suggests that amoxicillin-clavulanate provides excellent coverage against Pasteurella multocida, a common bacterium found in cat bites, as well as other potential pathogens such as streptococci, staphylococci, and anaerobes 1.
For patients with penicillin allergies, alternatives include doxycycline (100 mg twice daily), trimethoprim-sulfamethoxazole plus clindamycin, or a fluoroquinolone like ciprofloxacin plus clindamycin. It is essential to note that cat bites can lead to deep puncture wounds that seal quickly, trapping bacteria inside, and have a high infection risk (30-50%) due to the presence of Pasteurella multocida, which can cause rapid infection within 24-48 hours 1.
Other concerning bacteria include streptococci, staphylococci, and anaerobes. Besides antibiotics, proper wound care is crucial, including thoroughly cleaning the wound with soap and water, applying antiseptic, and seeking medical attention, especially for bites on hands, joints, or for people with compromised immune systems or diabetes. The choice of antibiotic should be guided by the severity of the bite, the patient's medical history, and the potential for antibiotic resistance, as outlined in the guidelines for the diagnosis and management of skin and soft tissue infections 1.
Key considerations in managing cat bite infections include:
- Prompt antibiotic treatment to prevent infection
- Proper wound care to reduce the risk of infection
- Awareness of potential pathogens, including Pasteurella multocida, streptococci, staphylococci, and anaerobes
- Consideration of patient factors, such as penicillin allergy, and adjustment of antibiotic therapy accordingly
- Monitoring for signs of infection and seeking medical attention if necessary.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Antibiotic Options for Cat Bites
- Amoxicillin/clavulanate is considered the first-line prophylactic antibiotic for cat bites, as stated in 2 and 3.
- Penicillin and its derivatives, such as benzylpenicillin, are also effective against Pasteurella multocida, a common bacterium found in cat bite wounds, according to 4.
- Other antibiotics, such as cefazolin and azithromycin, have also shown high susceptibility percentages against P. multocida, as reported in 4.
Considerations for Antibiotic Prophylaxis
- The decision to use antibiotic prophylaxis should be based on the risk of infection, with higher risk wounds (e.g., puncture wounds, wounds to the hand, and bites in immunosuppressed individuals) requiring more aggressive treatment, as mentioned in 2 and 3.
- The type of wound (e.g., laceration or puncture) does not appear to influence the effectiveness of prophylactic antibiotics, according to 5.
- Hand bites, in particular, may benefit from prophylactic antibiotics, with a statistically significant reduction in infection rate, as reported in 5.
Rare but Important Considerations
- Mycobacterium chelonae infection is a rare but possible complication of cat bites, and clinicians should consider the cat's diet and microbiome when treating unresponsive wounds, as described in 6.