What is the treatment for a cat bite?

Treatment for Cat Bites

Cat bites require immediate thorough wound cleansing with soap and water followed by prophylactic antibiotics with amoxicillin-clavulanate as first-line therapy due to the high risk of infection. 1

Initial Wound Management

1. Immediate wound care:

   • Thoroughly wash with soap and water 2, 1
   • Irrigate copiously with sterile saline using a 20-mL syringe or 20-gauge catheter 3
   • Apply virucidal agent such as povidone-iodine solution 2
   • Explore wound for tendon/bone involvement and foreign bodies 3

2. Wound closure decisions:

   • Small, clean wounds less than 8 hours old may be considered for primary closure 1
   • Facial wounds may be closed primarily after meticulous wound care 1
   • Puncture wounds or contaminated wounds should be left open to heal by secondary intention 1
   • Hand wounds require special attention due to higher risk of complications 4

Antibiotic Therapy

Oral Antibiotics (First-line):

• Amoxicillin-clavulanate (875/125 mg twice daily for 3-5 days) 2, 1
• This is the preferred agent due to excellent coverage against Pasteurella species (present in 75% of cat bites) and anaerobes 2, 1

Alternative Oral Options (for penicillin-allergic patients):

• Doxycycline 2
• Fluoroquinolones (ciprofloxacin, levofloxacin) plus metronidazole or clindamycin for anaerobic coverage 2

Intravenous Options (for severe infections):

• Ampicillin-sulbactam (first-line) 2, 1
• Piperacillin-tazobactam 1

Antibiotics to Avoid:

• First-generation cephalosporins (e.g., cephalexin)
• Penicillinase-resistant penicillins (e.g., dicloxacillin)
• Macrolides (e.g., erythromycin)
• Clindamycin alone
• These have poor activity against Pasteurella multocida 2, 1

Risk Factors for Infection

Cat bites have a higher infection risk due to:

• Deep puncture wounds with small skin openings 5
• High bacterial load including Pasteurella species, Staphylococci, Streptococci, and anaerobes 6
• Delayed presentation (>24 hours) significantly increases infection risk 5, 4
• Hand and lower extremity wounds have higher infection rates 5

Special Considerations

1. Tetanus prophylaxis:

   • Administer tetanus toxoid if vaccination is not current 1
   • Prefer Tdap over Td if not previously given 1

2. Rabies prevention:

   • Evaluate need for rabies prophylaxis with any cat bite 3
   • If indicated, begin rabies prophylaxis within 24 hours with both human rabies immune globulin and rabies vaccine 1
   • A healthy domestic cat may be confined and observed for 10 days 2

3. High-risk patients requiring closer monitoring:

   • Elderly patients with multiple comorbidities 1
   • Immunocompromised individuals 1
   • Asplenic patients (at risk for Capnocytophaga canimorsus sepsis) 1
   • Patients with cirrhosis 1

4. Indications for hospitalization:

   • Severe infections with systemic symptoms 1
   • Deep infections involving tendons or joints 4
   • Hand infections (especially with signs of tenosynovitis) 4
   • Immunocompromised patients with moderate to severe infections 1

Follow-up Care

• Follow-up within 24-48 hours either by phone or office visit 1
• Monitor for signs of infection: increasing pain, erythema, swelling, purulent discharge 1
• Standard treatment course is 7-14 days, with extended treatment (3-4 weeks) for osteomyelitis or septic arthritis 1

Common Pitfalls to Avoid

1. Underestimating cat bite severity due to small external wound appearance 7
2. Failing to recognize deep structure involvement, especially in hand wounds 4
3. Using inappropriate antibiotics that don't cover Pasteurella multocida 2
4. Delaying treatment, which significantly increases infection risk 5
5. Premature wound closure of potentially contaminated wounds 1