What is the recommended treatment for a cat scratch?

Treatment for Cat Scratches

For cat scratches, azithromycin is the recommended first-line treatment with a dosage of 500 mg on day 1 followed by 250 mg for 4 additional days for patients >45 kg. 1

Immediate Management

1. Wound Care:

   • Wash the cat scratch promptly with soap and water 2, 1
   • Do not allow cats to lick open wounds or cuts 2

2. Assessment for Risk Factors:

   • Immunocompromised status (particularly HIV-infected individuals)
   • Severity of the wound
   • Presence of symptoms such as lymphadenopathy, fever, or other systemic symptoms

Treatment Algorithm

For Immunocompetent Patients with Uncomplicated Cat Scratches:

• Most cases of cat scratch disease are self-limited and do not require antibiotic treatment 3
• Monitor for development of lymphadenopathy or systemic symptoms

For Patients with Symptomatic Cat Scratch Disease:

• First-line treatment: Azithromycin 500 mg on day 1, followed by 250 mg for 4 additional days (for patients >45 kg) 1
• Alternative treatments:
  • Erythromycin 500 mg four times daily for 2 weeks 1
  • Doxycycline 100 mg twice daily for 2 weeks 1

For Diabetic Patients:

• Amoxicillin-clavulanate 875/125 mg orally twice daily for 5-7 days 1
• For penicillin-allergic patients: doxycycline 100 mg twice daily 1

For Severe or Disseminated Disease:

• Doxycycline with or without rifampin for CNS involvement 1
• Consider hospitalization and IV antibiotics for high fever or extensive lymphadenopathy 1

Special Considerations

Immunocompromised Patients:

• HIV-infected persons, particularly those who are severely immunosuppressed, are at unusually high risk for developing relatively severe disease related to Bartonella infection 2, 1
• More aggressive treatment and monitoring may be required
• Consider risks of cat ownership 2

Clinical Follow-up:

• Clinical reassessment within 24-48 hours to evaluate response to antibiotic therapy in patients with worsening symptoms 1
• Schedule follow-up appointment in 1-2 weeks to assess resolution of symptoms 1
• Lymphadenopathy may persist for 1-6 months despite appropriate treatment 1

Prevention Strategies

1. For Cat Owners:

   • Implement flea control for cats 2, 1
   • Avoid rough play with cats 2, 1
   • Keep cats' nails trimmed 1
   • Supervise children's interactions with cats 1
   • If acquiring a cat, choose one >1 year old and in good health 2, 1

2. For Immunocompromised Individuals:

   • Consider the potential risks of cat ownership 2, 1
   • Wash hands after handling pets, especially before eating 2
   • Avoid contact with pets' feces 2

Common Pitfalls

• Misdiagnosis: Cat scratch disease should be included in the differential diagnosis of fever of unknown origin and lymphadenopathy syndromes 3
• Inappropriate antibiotic selection: Penicillins and first-generation cephalosporins have no in vivo activity against Bartonella and should not be used 1
• Delayed treatment: While most cases are self-limited, severe or persistent cases may require prompt antibiotic therapy 4
• Overlooking complications: Be vigilant for signs of disseminated disease including hepatosplenic involvement, osteomyelitis, encephalitis, and neuroretinitis 5