What is the recommended treatment for a cat bite?

Cat Bite Treatment

Cat bite wounds require immediate thorough cleaning with soap and water, followed by antibiotic prophylaxis with amoxicillin-clavulanate for 3-5 days to prevent infection, as cat bites have a high infection rate of 20-80%. 1, 2

Initial Management

1. Wound Cleaning:

   • Immediate and thorough washing of all bite wounds with soap and water
   • Follow with povidone-iodine solution irrigation as a virucidal agent
   • Irrigate for approximately 15 minutes 2
   • Avoid high-pressure irrigation which may spread bacteria into deeper tissues 2

2. Wound Assessment:

   • Evaluate depth, location, and time elapsed since bite
   • Hand wounds carry the highest risk of infection
   • Check for potential damage to tendons, joints, bones, or nerves
   • Consider radiography to rule out foreign bodies (broken teeth) 2

Antibiotic Treatment

Primary Antibiotic Choice:

• Amoxicillin-clavulanate 875/125 mg twice daily for 3-5 days 2, 1
• This covers Pasteurella multocida (found in ~90% of cats) and other common pathogens 1

For Penicillin-Allergic Patients:

• Doxycycline 100 mg twice daily (not for children under 8 years)
• Alternative: Fluoroquinolone plus metronidazole 2

Special Considerations

1. Tetanus Prophylaxis:

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   • Administer tetanus toxoid if status is outdated (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

2. Rabies Assessment:

   • Determine vaccination status of the cat if known
   • A healthy domestic cat that bites may be confined and observed for 10 days
   • For stray/unknown cats, consult local health officials regarding rabies post-exposure prophylaxis
   • If rabies is suspected, administer rabies immune globulin (RIG) and vaccine 2

3. Wound Closure:

   • Generally, cat bite wounds should not be closed primarily due to high infection risk
   • Facial wounds may be closed if there has been meticulous wound care and antibiotic prophylaxis 2

High-Risk Situations Requiring More Aggressive Management

• Deep puncture wounds (common with cat bites)
• Hand or face wounds
• Wounds near joints or tendons
• Immunocompromised patients
• Delayed presentation (>8 hours)
• Signs of established infection (redness, swelling, pain, purulent discharge)

Follow-up

• Schedule follow-up within 24-48 hours to assess for signs of infection
• Monitor for increasing redness, swelling, pain, warmth, or drainage
• Consider hospitalization and IV antibiotics if infection progresses despite appropriate therapy 2

Common Pitfalls to Avoid

1. Underestimating cat bites: Despite their small appearance, cat bites have a much higher infection rate (20-80%) than dog bites (3-18%) due to their puncture-type wounds and high carriage of Pasteurella multocida 1, 3

2. Delayed treatment: Cat bite infections can progress rapidly, particularly those involving the hand

3. Inadequate antibiotic coverage: Empiric therapy must cover Pasteurella multocida, which is sensitive to penicillins but resistant to dicloxacillin, cephalexin, and clindamycin 1

4. Insufficient wound cleaning: Thorough irrigation is critical to reduce bacterial load and prevent infection 2