What is the treatment for a cat bite?

Treatment for Cat Bites

Cat bites require immediate thorough wound cleansing with soap and water followed by povidone-iodine irrigation, and prophylactic antibiotics with amoxicillin-clavulanate for 3-5 days to prevent serious infections. 1, 2

Initial Management

1. Immediate Wound Care:

   • Thoroughly wash all bite wounds with soap and water
   • Irrigate with povidone-iodine solution
   • For deep wounds, irrigate copiously for about 15 minutes 1, 2

2. Wound Assessment:

   • Evaluate for depth, location, and potential involvement of tendons, joints, or bones
   • Cat bites, especially to the hand, have a high risk of infection due to their puncture-like nature 3, 4
   • Consider whether the wound should remain open or be sutured (facial wounds may be closed if there has been meticulous wound care) 2

Antibiotic Prophylaxis

First-line antibiotic: Amoxicillin-clavulanate 875/125 mg twice daily for 3-5 days 2, 4

For penicillin-allergic patients:

• Doxycycline 100 mg twice daily (avoid in children under 8 years) 2
• Alternative: Fluoroquinolone plus metronidazole, or clindamycin plus TMP-SMZ 2

Potential Pathogens

• Cat bites commonly contain Pasteurella multocida (found in >50% of cat bites) 3, 5
• Other common pathogens include Staphylococcus aureus, Bacteroides species, and anaerobes 5

Additional Considerations

1. Tetanus Prophylaxis:

   • Evaluate tetanus vaccination status
   • Administer tetanus toxoid if status is outdated (>5 years) or unknown 1, 2

2. Rabies Risk Assessment:

   • Assess rabies risk based on:
     • Vaccination status of the cat
     • Whether the cat is domestic or stray
     • Whether the attack was provoked or unprovoked 1
   • If rabies risk exists, consult with local health officials regarding rabies post-exposure prophylaxis (RIG and vaccine series) 1, 2

3. Observation of the Animal:

   • A healthy domestic cat that bites a person may be confined and observed for 10 days
   • Any illness in the animal during this period should be evaluated by a veterinarian and reported to public health authorities
   • If the cat is stray or unwanted, it should either be observed for 10 days or euthanized and tested for rabies 1

Follow-up Care

• Schedule follow-up within 24-48 hours to assess for signs of infection 2
• Monitor for increasing redness, swelling, pain, warmth, or drainage
• Elevate the affected area if there is inflammation 2
• Consider hospitalization if infection progresses despite appropriate therapy, especially in elderly or immunocompromised patients 2, 6

Special Precautions for HIV-Infected Persons

HIV-infected individuals should take additional precautions with cats:

• Adopt cats older than 1 year and in good health
• Keep cats indoors and avoid allowing them to hunt
• Clean litter boxes daily (preferably by an HIV-negative person)
• Implement flea control to reduce risk of Bartonella infection
• Avoid activities that might result in cat scratches or bites 1

Common Pitfalls to Avoid

• Underestimating cat bites: Despite their small appearance, cat bites can cause serious infections due to deep puncture wounds and high bacterial load 3, 6
• Delayed treatment: Cat bite infections can progress rapidly to sepsis, especially in elderly or immunocompromised patients 6
• Inadequate wound exploration: Failure to identify foreign bodies or damage to deeper structures can lead to complications 2, 4
• Inappropriate antibiotic selection: Using antibiotics without coverage for Pasteurella multocida can lead to treatment failure 3, 5