What is the recommended treatment for a cat bite?

Treatment for Cat Bite

Cat bites require immediate wound cleaning with soap and water, followed by prophylactic antibiotics with amoxicillin-clavulanate as first-line therapy due to high infection risk, especially for hand wounds. 1

Initial Wound Management

1. Immediate wound cleansing:

   • Thoroughly wash with soap and water 1
   • Consider adding povidone-iodine solution irrigation as a virucidal agent 1
   • Remove superficial debris without extensive debridement 1

2. Wound assessment:

   • Evaluate depth, location, and time since injury
   • Cat bites have higher infection rates than dog bites despite less crush injury 1
   • Hand wounds carry particularly high infection risk (45% of cat bites affect hands) 2
   • Puncture wounds (56% of cat bites) have higher infection risk than abrasions or lacerations 2

Antibiotic Therapy

Outpatient Treatment

• First-line therapy: Amoxicillin-clavulanate (B-II recommendation) 1, 3
• Alternatives for penicillin-allergic patients:
  • Doxycycline 1
  • Fluoroquinolones (ciprofloxacin, levofloxacin) plus metronidazole or clindamycin for anaerobic coverage 1

Inpatient Treatment (for severe infections)

• IV options:
  • β-lactam/β-lactamase combinations (ampicillin-sulbactam)
  • Piperacillin-tazobactam
  • Second-generation cephalosporins (cefoxitin)
  • Carbapenems (ertapenem, imipenem, meropenem) 1

Antibiotics to Avoid

• First-generation cephalosporins (cephalexin)
• Penicillinase-resistant penicillins (dicloxacillin)
• Macrolides (erythromycin)
• Clindamycin alone (all have poor activity against Pasteurella multocida) 1

Microbiology Considerations

Cat bites have a complex polymicrobial profile:

• Pasteurella multocida (75% of cat bites) 1, 3
• Anaerobes (65% of cat bites) 1
• Staphylococci and streptococci (40% of bites) 1
• Capnocytophaga canimorsus (especially dangerous in immunocompromised patients) 1

Risk Factors for Infection

Factors associated with higher infection risk include:

• Older patient age 2
• Longer time interval until treatment 2
• Deeper wounds, especially punctures 2
• Hand location 2
• Wounds from pet cats rather than strays 2

Additional Considerations

1. Tetanus prophylaxis: Administer as indicated based on immunization status 1, 3

2. Rabies risk assessment:

   • Healthy domestic cats should be confined and observed for 10 days 1
   • For stray/unknown cats, consider rabies post-exposure prophylaxis 1
   • Rabies post-exposure prophylaxis includes wound cleaning, rabies immune globulin, and vaccination 1

3. Wound closure:

   • Infected wounds should not be closed 1
   • For non-infected wounds seen <8 hours after injury, consider Steri-Strips rather than sutures 1
   • Facial wounds may be an exception and can be closed primarily with prophylactic antibiotics 1

4. Follow-up:

   • All patients should be seen within 24 hours either by phone or office visit 1
   • Monitor for signs of progressive infection despite treatment 1
   • For hand wounds, elevate the extremity to reduce swelling 1

Complications to Monitor

• Septic arthritis
• Osteomyelitis (especially with hand wounds) 4
• Tendonitis or intratendinous abscess 5
• Subcutaneous abscess formation
• Rarely, bacteremia and sepsis 1

Cat bites should never be underestimated, as even small external wounds can lead to serious deep infections requiring surgical intervention and prolonged antibiotic therapy 4.