What is the recommended treatment for a cat scratch?

Treatment of Cat Scratch Wounds

For cat scratch wounds, immediate thorough washing with soap and water is the recommended first-line treatment to prevent infection. 1

Initial Management

• Immediately clean the wound thoroughly with soap and water 1
• Apply an antiseptic solution after cleaning
• Cover with a clean, sterile bandage if needed
• Monitor for signs of infection (redness, swelling, warmth, increasing pain)

Antibiotic Treatment Indications

For Simple Cat Scratches (No Signs of Infection)

• Most cases of cat scratches do not require antibiotic therapy and resolve spontaneously 2, 3
• Continue to monitor the wound for signs of infection

For Cat Scratches with Signs of Infection or Cat Scratch Disease

If signs of infection develop (lymphangitis, progressive edema, lymphadenopathy):

1. First-line treatment: Azithromycin

   • Adults ≥45.5 kg: 500 mg on day 1, followed by 250 mg for 4 additional days
   • Children <45.5 kg: 10 mg/kg on day 1, followed by 5 mg/kg for 4 more days 1
   • Azithromycin has been shown to reduce lymph node size with 80% regression at 30 days compared to placebo 1

2. Alternative antibiotics (if azithromycin is contraindicated):

   • Rifampin (87% efficacy) 4
   • Ciprofloxacin (84% efficacy) 4
   • Trimethoprim-sulfamethoxazole (58% efficacy) 4
   • Doxycycline 100 mg twice daily (for penicillin-allergic patients) 1

3. Special populations:

   • Diabetic patients: Amoxicillin-clavulanate 875/125 mg orally twice daily for 5-7 days 1
   • Immunocompromised patients: Erythromycin 500 mg four times daily or doxycycline 100 mg twice daily for 2 weeks to 2 months 1
   • Severe infection (high fever, extensive lymphadenopathy): May require hospitalization and IV antibiotics, with gentamicin being reserved for severely ill patients 1, 3

Follow-up Care

• Clinical reassessment within 24-48 hours if lymphangitis or edema is present 1
• Schedule follow-up appointment in 1-2 weeks to assess resolution 1
• Inform patients that lymphadenopathy may persist for 1-6 months despite appropriate treatment 1
• Instruct patients to return sooner if symptoms worsen or new symptoms develop 1

Prevention Strategies

• Keep cats' nails trimmed 1
• Avoid rough play with cats 1
• Implement flea control for cats (fleas transmit Bartonella between cats) 1, 5
• Supervise children's interactions with cats 1
• Immunocompromised individuals should be especially cautious with cat scratches due to higher risk of developing serious Bartonella infections 1

Clinical Pearls

• Cat scratch disease can present atypically in up to 25% of cases with manifestations such as ocular involvement, encephalopathy, hepatitis, or osteomyelitis 3
• Recent studies show that in pediatric patients with regional lymphadenopathy not responding to nonspecific antibiotics, cat scratch disease should be suspected 6
• While most cases resolve with a 5-day course of azithromycin, some patients may require extended treatment (10-14 days) or additional antibiotics 6
• Serological testing for Bartonella henselae (titers >1:256) can confirm diagnosis in uncertain cases 5