What to do for worsening cellulitis and mild fever after being bitten by a cat and taking 2 doses of Augmentin (amoxicillin-clavulanate)?

Management of Worsening Cat Bite Cellulitis After Initial Augmentin Treatment

You need immediate hospitalization and intravenous antibiotics for worsening cellulitis from a cat bite despite oral Augmentin therapy, as evidenced by increasing pain, swelling, redness, and fever.

Assessment of Current Situation

Your presentation shows clear signs of treatment failure with oral Augmentin:

• Worsening pain, swelling, and redness of the hand
• Fever of 100.8°F
• Only 2 doses of oral Augmentin taken so far

Recommended Management

Immediate Action Required

1. Seek emergency care immediately - Cat bite cellulitis that is worsening despite antibiotics requires prompt medical attention
2. Hospitalization for IV antibiotics - The progression of symptoms indicates treatment escalation is necessary

Antibiotic Therapy

• First-line IV therapy: Ampicillin-sulbactam (1.5-3.0 g every 6-8 hours IV) 1

  • Provides excellent coverage against Pasteurella multocida (the most common pathogen in cat bites)
  • Also covers anaerobes and other typical cat bite organisms

• Alternative IV options if allergic to penicillins:

  • Piperacillin-tazobactam (3.37 g every 6-8 hours IV) 1
  • Moxifloxacin 400 mg daily IV (good monotherapy with anaerobic coverage) 1

Additional Management

• Elevation of the affected hand to reduce edema and improve circulation 1
• Wound assessment for potential abscess formation requiring drainage
• Close monitoring for signs of deeper infection or sepsis

Rationale for Hospitalization

Cat bites have a high risk of serious infection because:

1. Cat teeth create deep puncture wounds that are difficult to clean
2. Pasteurella multocida, a common oral flora in cats, can cause rapidly progressive infection
3. Worsening symptoms despite Augmentin indicate potential treatment failure or deeper infection

Common Pitfalls to Avoid

• Don't continue oral antibiotics alone when cellulitis is worsening with fever
• Don't delay seeking medical attention - cat bite infections can progress rapidly
• Don't underestimate the severity of hand infections, which can lead to compartment syndrome, tenosynovitis, or osteomyelitis
• Don't miss the need for surgical evaluation - some infections require debridement

Duration of Treatment

Intravenous antibiotics should be continued until significant clinical improvement, typically 2-5 days, followed by oral antibiotics to complete a 7-14 day total course 1.

Follow-up Care

After resolution of the acute infection:

• Monitor for complete resolution of symptoms
• Ensure full range of motion of the hand is restored
• Watch for any signs of recurrent infection

Remember that hand infections from animal bites can have serious consequences including loss of function if not treated aggressively and promptly.