Emergency Room Management of Cat Bites
Cat bites require immediate thorough wound irrigation, prophylactic antibiotics (amoxicillin-clavulanate), and careful assessment for deep tissue involvement, as they have a high infection rate of 30-50% and can rapidly progress to serious complications.
Initial Assessment and Wound Management
Immediate Wound Care
- Thoroughly irrigate the wound with copious amounts of warm or room temperature potable water until all foreign matter is removed 1
- Continue irrigation for at least 30 seconds 2
- Avoid high-pressure irrigation as it may spread bacteria into deeper tissue layers 1
- Debride any necrotic tissue to reduce bacterial burden 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, warmth)
- Foreign bodies
- Cat bites often appear deceptively minor but can cause significant deep tissue damage 3
Antibiotic Management
Prophylactic Antibiotics
- All cat bites should receive prophylactic antibiotics due to their high infection risk (30-50%) 1
- Amoxicillin-clavulanate is the first-line treatment 1, 4
- Covers Pasteurella multocida (found in 75% of cat bites) and other common pathogens
- Typical adult dose: 875/125 mg twice daily for 5-7 days
Alternative Antibiotics (for penicillin-allergic patients)
- Doxycycline 1
- Fluoroquinolones (e.g., ciprofloxacin) plus metronidazole or clindamycin for anaerobic coverage 1
Important Caution
- Avoid first-generation cephalosporins, penicillinase-resistant penicillins, macrolides, and clindamycin alone as they have poor activity against P. multocida 1
Special Considerations
High-Risk Bite Locations
- Hand bites require particular attention due to high risk of complications 3
- Bites near joints, tendons, or bones need careful evaluation
- Consider hospitalization and IV antibiotics for:
- Deep wounds
- Hand involvement
- Signs of systemic infection
- Immunocompromised patients
- Severe local inflammation
Wound Closure
- Primary closure is generally avoided for cat bites due to infection risk
- If closure is necessary, consider delayed primary closure after 3-5 days of observation
Additional Preventive Measures
- Assess tetanus immunization status and update if needed 2
- Evaluate need for rabies post-exposure prophylaxis based on:
- Vaccination status of the cat
- Whether the cat can be observed for 10 days
- Local rabies epidemiology 2
Follow-up Care
Discharge Instructions
- Elevate the affected area if inflamed 2
- Apply antibiotic ointment and cover with a clean occlusive dressing 1, 2
- Monitor for signs of infection for at least 48 hours 2
- Return immediately if signs of worsening infection develop:
- Increasing pain, redness, swelling
- Fever or chills
- Purulent drainage
- Lymphangitis (red streaking)
Complications to Watch For
- Tenosynovitis
- Septic arthritis
- Osteomyelitis
- Subcutaneous abscess formation 2, 5
- Systemic infection/septicemia 4
Clinical Pearls
- Cat bite infections can develop rapidly, sometimes within 3 hours of the bite 4
- Even small, seemingly trivial cat bite wounds can lead to serious infections 5, 6
- Pasteurella multocida is the predominant pathogen (70-75% of cat bites) and requires appropriate antibiotic coverage 4
- Hand infections from cat bites can lead to long-term disability if not treated appropriately 3