What is the recommended treatment for a cat bite?

Treatment of Cat Bites

Amoxicillin-clavulanate (875/125 mg twice daily) is the first-line treatment for cat bites due to excellent coverage against common pathogens including Pasteurella multocida, staphylococci, streptococci, and anaerobic bacteria. 1

Immediate Wound Management

1. Initial Wound Care

   • Immediate gentle irrigation with water or dilute povidone-iodine solution
   • Thorough cleaning without damaging surrounding tissues
   • Debridement of necrotic tissue if present
   • Avoid high-pressure irrigation which may spread bacteria into deeper tissues 2, 1

2. Wound Closure

   • Generally avoid suturing cat bite wounds when possible as it increases infection risk
   • Facial wounds may be closed primarily with prophylactic antibiotics
   • For wounds <8 hours old, consider approximation with Steri-Strips rather than sutures
   • Consider delayed primary closure for wounds >8 hours old 1

Antibiotic Therapy

First-line Treatment:

• Amoxicillin-clavulanate 875/125 mg twice daily (oral) 2, 1
  • Provides excellent coverage against Pasteurella multocida (found in ~90% of cats) 3
  • Effective against staphylococci, streptococci, and anaerobic bacteria

Alternative Options (for penicillin-allergic patients):

• Fluoroquinolone (ciprofloxacin or levofloxacin) plus metronidazole 1
• Doxycycline (100 mg twice daily) - excellent activity against P. multocida 2
• Second/third-generation cephalosporins with anaerobic coverage 1

Intravenous Options (for severe infections):

• Ampicillin-sulbactam (1.5-3.0 g every 6-8 hours)
• Piperacillin-tazobactam (3.37 g every 6-8 hours) 2

Risk Factors for Infection

• Cat bites have a 20-80% infection rate (compared to only 3-18% for dog bites) 3, 4
• Hand wounds carry the highest infection risk and warrant special attention 1, 5
• Other risk factors include:
  • Older patient age
  • Longer time intervals until treatment
  • Deeper wounds (especially punctures)
  • More severe wounds 5

Special Considerations

1. Hand Infections

   • Cat bites to the hand require aggressive treatment due to higher risk of treatment failure
   • May require hospitalization and intravenous antibiotics 1
   • Consider surgical consultation for deep hand infections

2. High-Risk Patients

   • Immunocompromised patients
   • Elderly individuals
   • Patients with cirrhosis or asplenia
   • Those with severe comorbidities
   • These patients require broader spectrum antibiotics and closer monitoring 1

3. Prophylaxis Considerations

   • Tetanus prophylaxis if vaccination status is outdated or unknown
   • Rabies prophylaxis should be considered for feral cat bites (consult local health department) 1, 6

Treatment Duration and Follow-up

• Standard treatment duration: 5-7 days for uncomplicated infections 1
• Follow-up within 24-48 hours to assess for signs of worsening infection
• Extend treatment if no improvement after 5 days 1

Indications for Hospitalization

• Severe infections with systemic symptoms
• Deep infections involving tendons or joints
• Hand infections not responding to oral therapy
• Immunocompromised patients with moderate to severe infections 1

Cat bites should never be taken lightly, especially those to the hand, as they can lead to serious infections with significant morbidity if not properly treated.