What is the appropriate management for a cat bite?

Management of Cat Bites

Cat bites require immediate wound cleaning, antibiotic prophylaxis with amoxicillin-clavulanate, and assessment for rabies risk to prevent serious infections that can lead to significant morbidity and mortality.

Initial Wound Management

1. Immediate wound cleaning:

   • Thoroughly wash all bite wounds with soap and water 1
   • Irrigate copiously with sterile normal saline using a 20-mL or larger syringe 2
   • Avoid high-pressure irrigation which may spread bacteria into deeper tissues 1
   • Apply a virucidal agent such as povidone-iodine solution 1

2. Wound assessment:

   • Explore for tendon or bone involvement and possible foreign bodies 2
   • Assess depth and location (hand wounds carry highest infection risk) 3
   • Document wound characteristics (puncture, laceration, abrasion) 3

3. Wound closure:

   • Primary closure is generally not recommended except for facial wounds 1
   • Facial wounds may be closed after copious irrigation and with preemptive antibiotics 1
   • Other wounds may be approximated but not fully closed 1

Antibiotic Therapy

1. Prophylactic antibiotics:

   • Amoxicillin-clavulanate is the first-line antibiotic for cat bites 1, 2, 4
   • For outpatient treatment: amoxicillin-clavulanate (oral) 1
   • For inpatient treatment: β-lactam/β-lactamase combinations (ampicillin-sulbactam), piperacillin/tazobactam, second-generation cephalosporins (cefoxitin), or carbapenems 1

2. Antibiotics to avoid:

   • First-generation cephalosporins (cephalexin)
   • Penicillinase-resistant penicillins (dicloxacillin)
   • Macrolides (erythromycin)
   • Clindamycin alone
   • These have poor activity against Pasteurella multocida and should be avoided 1

3. Duration of therapy:

   • 3-5 days for prophylaxis of fresh, deep wounds 1
   • 7-14 days for established infections
   • 3-4 weeks for synovitis or 4-6 weeks for osteomyelitis 1

Special Considerations

1. High-risk wounds requiring prophylactic antibiotics:

   • Cat bites (30-50% infection rate) 1, 3
   • Puncture wounds 3
   • Hand wounds (especially over joints or tendons) 5, 6
   • Wounds in immunocompromised patients 1
   • Wounds presenting >8 hours after injury 1, 3

2. Rabies prophylaxis assessment:

   • Evaluate vaccination status of the cat 1
   • For domestic cats with unknown vaccination status:
     • Confine and observe the cat for 10 days 1
     • Any illness in the animal during confinement should be evaluated by a veterinarian 1
   • For stray or unwanted cats:
     • The animal should be euthanized and tested for rabies 1
   • If rabies prophylaxis is needed:
     • Rabies immune globulin at presentation
     • Vaccination on days 0,3,7, and 14 2

3. Tetanus prophylaxis:

   • Administer tetanus toxoid booster if >5 years since last dose for dirty wounds 1
   • Complete primary series if not previously vaccinated 1

Complications to Monitor

1. Infection signs requiring immediate attention:

   • Increasing pain, swelling, redness beyond 24 hours
   • Lymphangitis or lymphadenopathy
   • Fever or systemic symptoms
   • Purulent drainage

2. Potential serious complications:

   • Septic arthritis
   • Osteomyelitis (especially with hand wounds) 5
   • Tenosynovitis
   • Abscess formation
   • Rarely, bacteremia or sepsis (especially in immunocompromised patients) 1

3. Common pathogens:

   • Pasteurella multocida (75% of cat bites) 1, 4
   • Staphylococcus and Streptococcus species (40%) 1
   • Anaerobes (65% of cat bites) 1
   • Bartonella henselae (cat scratch disease) 6

Cat bites should never be underestimated, as they can lead to rapid progression of infection within 24 hours due to their puncture-type wounds that can inoculate bacteria deep into tissues, particularly when located on the hand 6, 3.