Antibiotic Treatment for Cat Bites
Amoxicillin-clavulanate is the first-line antibiotic treatment for cat bite infections due to its excellent coverage against Pasteurella multocida and other common bite wound pathogens. 1
Microbiology and Infection Risk
Cat bites have a high infection risk (20-80%) compared to dog bites (3-18%) 2, 3. The microbiology of cat bite wounds includes:
- Pasteurella multocida (found in 75% of cat bite wounds) 4, 3
- Staphylococci and streptococci (found in ~40% of bites) 4
- Anaerobic bacteria (present in 65% of cat bites) 4
- Capnocytophaga species 5, 6
Studies show approximately 90% of domestic cats carry P. multocida in their oral cavity 2, making this the primary pathogen of concern.
First-Line Antibiotic Recommendations
- Oral therapy: Amoxicillin-clavulanate 875/125 mg twice daily 4, 1
- Provides excellent coverage against P. multocida and other common pathogens
- Supported by clinical evidence and guidelines
Alternative Antibiotic Options
For patients with penicillin allergies:
- Doxycycline (excellent alternative for penicillin-allergic patients) 1
- Clindamycin plus a fluoroquinolone 1
- Metronidazole plus a fluoroquinolone or trimethoprim-sulfamethoxazole 1
Antibiotics to Avoid
The following antibiotics should be avoided due to poor activity against P. multocida 4, 1:
- First-generation cephalosporins (e.g., cephalexin)
- Penicillinase-resistant penicillins (e.g., dicloxacillin)
- Macrolides (e.g., erythromycin)
- Clindamycin alone
Intravenous Options for Severe Infections
For severe infections requiring parenteral therapy:
- Ampicillin-sulbactam
- Piperacillin-tazobactam
- Ertapenem or other carbapenems
- Second-generation cephalosporins (e.g., cefoxitin) 4, 1
Treatment Duration and Monitoring
- Standard duration: 5-7 days for uncomplicated infections 1
- Follow-up within 24-48 hours to assess response 1
- Extend treatment if no improvement is seen after 5 days
- Consider hospitalization if infection progresses despite appropriate therapy 4
Special Considerations
- Hand bites: More serious and prone to complications; may require longer treatment
- Deep puncture wounds: Higher risk of infection; require careful monitoring
- Immunocompromised patients: Consider broader spectrum antibiotics and possible hospitalization 1
- Complications: Watch for septic arthritis, osteomyelitis, abscess formation, tendonitis, and bacteremia 4
Wound Management
In addition to antibiotics, proper wound care is crucial:
- Cleanse thoroughly with sterile normal saline
- Remove superficial debris
- Elevate the affected area 4, 1
- Do not close infected wounds
- Consider delayed primary closure for wounds >8 hours old 1
Preventative Measures
- Ensure tetanus prophylaxis if vaccination status is outdated or unknown 1
- Consider rabies prophylaxis for feral cat bites 1
Remember that cat bites can lead to rapid onset of infection, with symptoms often emerging as early as 3 hours after the bite 3. Prompt antibiotic treatment is essential to prevent complications.