What is the management for a cat bite to the hand?

Management of Cat Bite to the Hand

Cat bites to the hand require immediate medical attention with thorough wound irrigation, prophylactic antibiotics (amoxicillin-clavulanate), and careful monitoring due to their high infection risk (30-50%) and potential for severe complications. 1

Initial Assessment and Management

Immediate Care

• Wound Irrigation: Thoroughly irrigate the wound with sterile saline or running tap water until all visible debris is removed 1
  • Avoid high-pressure irrigation as it may spread bacteria into deeper tissues 1
  • Do not use povidone-iodine solutions for irrigation as they show no benefit over saline or tap water 1

Wound Examination

• Assess for:
  • Depth of penetration (cat teeth can cause deep puncture wounds)
  • Proximity to joints, tendons, or bones
  • Signs of infection (redness, swelling, pain, purulent drainage)
  • Functional impairment of the hand

Wound Management

• Do not close cat bite wounds to the hand - leave open to heal by secondary intention 1
  • Exception: Facial wounds may be closed after thorough irrigation and with prophylactic antibiotics 1
• Remove any necrotic tissue if present 1
• Elevate the hand to reduce swelling 1

Antibiotic Therapy

Prophylactic Antibiotics

• All cat bites to the hand require prophylactic antibiotics regardless of appearance 1
• First-line therapy: Amoxicillin-clavulanate (oral) for 3-5 days 1
  • Typical dosing: 875/125 mg twice daily
  • This covers Pasteurella multocida (found in 75% of cat bites) and other common pathogens 1

Alternative Antibiotics

• For penicillin-allergic patients: Doxycycline 1
• Avoid: First-generation cephalosporins, dicloxacillin, macrolides, and clindamycin as they have poor activity against P. multocida 1

Intravenous Therapy

• Consider for:
  • Severe infections
  • Systemic symptoms (fever, chills)
  • Immunocompromised patients
  • Deep hand infections
• Options include: ampicillin-sulbactam, piperacillin-tazobactam, or ertapenem 1

Follow-up and Monitoring

• Re-evaluate within 24-48 hours 1
• Monitor for signs of worsening infection:
  • Increasing pain, swelling, redness
  • Purulent drainage
  • Fever
  • Lymphangitis (red streaking up the arm)
  • Decreased hand function

Potential Complications

• Hand infections from cat bites can be particularly severe due to:

  • Proximity of tendons, joints, and bones
  • Limited soft tissue between skin and deeper structures
  • High bacterial inoculation from deep puncture wounds 2

• Specific complications to monitor for:

  • Tenosynovitis
  • Septic arthritis
  • Osteomyelitis
  • Compartment syndrome (rare but serious) 3
  • Carpal tunnel syndrome (rare) 3

Additional Considerations

Tetanus Prophylaxis

• Administer tetanus toxoid if vaccination not current within past 10 years 1
• Tdap preferred over Td if not previously given 1

Rabies Risk Assessment

• Consider rabies prophylaxis for bites from feral cats or in areas with high rabies prevalence 1
• Consult local health department for guidance on rabies risk 1

Special Situations

Infected Cat Bites

• If already infected at presentation:
  • More aggressive debridement may be needed
  • Consider surgical consultation
  • May require intravenous antibiotics
  • Longer course of antibiotics (typically 7-14 days) 1

Immunocompromised Patients

• Lower threshold for admission and intravenous antibiotics
• More aggressive wound management
• Closer follow-up

Key Pitfalls to Avoid

1. Underestimating cat bites: Despite their small appearance, cat bites have higher infection rates (30-50%) than dog bites (5-25%) 1
2. Delayed treatment: Cat bites to the hand should be treated as medical urgencies
3. Inappropriate antibiotic selection: Ensure coverage for Pasteurella multocida
4. Premature wound closure: Cat bite wounds to the hand should generally not be closed primarily
5. Inadequate follow-up: All cat bite wounds to the hand require close monitoring