What is the recommended treatment for bacterial infections caused by cat bites?

Treatment of Bacterial Infections from Cat Bites

Amoxicillin-clavulanate is the first-line antibiotic treatment for bacterial infections caused by cat bites due to its excellent coverage against common pathogens including Pasteurella multocida, staphylococci, streptococci, and anaerobic bacteria. 1, 2

Immediate Management

1. Wound Care:

   • Thoroughly irrigate the wound until there is no obvious debris or foreign matter 3
   • Use running tap water or sterile saline solutions rather than antiseptic agents 3
   • For deep or severe wounds, consider surgical debridement and drainage 1

2. Medical Evaluation:

   • Cat bite wounds should be evaluated in a medical facility as soon as possible 3
   • Assess for signs of infection: redness, swelling, increased pain, foul-smelling drainage, or fever 3

Antibiotic Treatment

First-line Treatment:

• Amoxicillin-clavulanate 875/125 mg twice daily for 5-7 days 1, 2
• Take with food to reduce gastrointestinal upset 4

For Penicillin-Allergic Patients:

• Mild to moderate infections: Fluoroquinolone (levofloxacin 500mg daily or moxifloxacin 400mg daily) + metronidazole (500mg twice daily) 1
• Severe infections: Consider IV therapy with moxifloxacin or levofloxacin (750mg/day) 1
• Alternative options: Clindamycin, azithromycin, or doxycycline 1

Special Considerations

High-Risk Situations Requiring More Aggressive Management:

• Bites to the hand (higher risk of treatment failure)
• Immunocompromised patients
• Deep infections involving tendons or joints
• Presence of systemic symptoms
• Elderly patients or those with severe comorbidities 1

Indications for Hospitalization:

• Severe infections with systemic symptoms
• Deep infections involving tendons or joints
• Hand infections
• Immunocompromised patients with moderate to severe infections 1

Prevention

• Cat owners should be aware that cat ownership increases risk for Bartonella infection, toxoplasmosis, and enteric infections 3
• Consider adopting cats >1 year old and in good health to reduce risk of infections 3
• Avoid activities that might result in cat scratches or bites 3
• Wash hands thoroughly after handling cats 3
• Implement flea control for cats to reduce risk of Bartonella infection 3

Follow-up Care

• Follow-up within 24-48 hours to assess for signs of infection 1
• If patient develops redness, swelling, foul-smelling wound drainage, increased pain, or fever, remove any dressing, inspect the wound, and obtain medical care 3
• Complete the full course of antibiotics even if symptoms improve to prevent antibiotic resistance 4

Common Pitfalls to Avoid

1. Delayed treatment: Cat bites have a high risk of infection, particularly with Pasteurella multocida, which can cause rapid onset of infection (within 24 hours) 2, 5

2. Inadequate wound exploration: Failure to identify deep structure involvement, foreign bodies, or tendon/joint penetration 1

3. Inappropriate antibiotic selection: Using antibiotics without coverage for Pasteurella multocida 6, 5

4. Premature wound closure: Suturing cat bite wounds increases infection risk; consider delayed closure for contaminated wounds 1, 7

5. Incomplete antibiotic course: Stopping antibiotics early can lead to treatment failure and antibiotic resistance 4