Recommended Antibiotic for Cat Bites
Amoxicillin-clavulanate (875/125 mg twice daily) is the recommended first-line antibiotic for cat bite infections, providing excellent coverage against common pathogens including Pasteurella multocida, Staphylococci, Streptococci, and anaerobic bacteria. 1
Rationale for Amoxicillin-Clavulanate
- Cat bites have a high infection rate (20-80%) compared to dog bites (3-18%) 2, 3
- Pasteurella multocida is present in approximately 90% of cats' oral cavities 2
- Amoxicillin-clavulanate has demonstrated 100% susceptibility against P. multocida isolates 2
- This recommendation is supported by the Infectious Diseases Society of America and the American College of Physicians 1
Alternative Options for Penicillin-Allergic Patients
For patients with penicillin allergy, the following alternatives are recommended:
- First choice: Fluoroquinolone (levofloxacin 500mg daily or moxifloxacin 400mg daily) plus metronidazole (500mg twice daily) 1, 4
- Other options: Clindamycin, azithromycin (94.02% susceptibility against P. multocida) 1, 2
- Important note: Cephalosporins should not be used in patients with history of anaphylaxis, angioedema, or urticaria with penicillins 1
Duration of Treatment
- Typically 5-7 days for uncomplicated infections 1
- May be extended if improvement is not seen
Special Considerations
Hand Infections
- Cat bite infections of the hand warrant special attention due to higher risk of treatment failure 1, 5
- May require more aggressive treatment and possibly hospitalization 1
- Surgical drainage may be necessary alongside antibiotic therapy 5
High-Risk Patients
The following patients require broader spectrum antibiotics, closer monitoring, and possible hospitalization:
- Immunocompromised patients
- Elderly individuals
- Patients with cirrhosis or asplenia
- Patients with severe comorbidities 1
Wound Care
- Thoroughly irrigate the wound with running tap water or sterile saline until there is no obvious debris 1
- Avoid antiseptic agents for irrigation as they may damage tissue 1
- Suturing should generally be avoided when possible as it may increase infection risk 1
- Consider delayed primary closure for wounds >8 hours old 1
Warning Signs
Patients should seek immediate medical attention if they develop:
- Increasing redness or swelling
- Increased pain
- Foul-smelling drainage
- Fever 1
Prophylaxis
- Prophylactic antibiotics (amoxicillin-clavulanate) are recommended for all deep puncture wounds, immunocompromised patients, and wounds involving joints, tendons, or bones 1
- Tetanus toxoid (0.5 mL intramuscularly) should be administered if vaccination status is outdated or unknown 1
- Consider rabies prophylaxis for feral cat bites, consulting local department of health 1