What is the recommended treatment for cat bites and scratches?

Management of Cat Bites and Scratches

Immediate and thorough wound cleaning with soap and water followed by amoxicillin-clavulanate is the recommended first-line treatment for cat bites and scratches to prevent infection and potential complications. 1

Immediate Wound Care

1. Clean the wound thoroughly:

   • Wash with soap and water immediately
   • Irrigate with sterile normal saline to remove debris 1
   • Apply povidone-iodine solution as a virucidal agent 2
   • Elevate the injured body part if swelling is present 1

2. Wound assessment:

   • Evaluate depth, location, and type (puncture, laceration, scratch)
   • Pay special attention to hand wounds, which have higher infection risk 3
   • Look for pain disproportionate to injury near bones/joints (may suggest periosteal penetration) 1

Antibiotic Therapy

Indications for Prophylactic Antibiotics:

• Hand wounds (strong indication - NNT = 4) 4
• Deep puncture wounds 3
• Full-thickness wounds 3
• Wounds with delayed presentation (>8 hours) 3

Antibiotic Regimen:

• First-line (outpatient): Amoxicillin-clavulanate 1
• Alternative for penicillin allergy: Consult local antibiotic guidelines
• For severe infections (inpatient):
  • β-lactam/β-lactamase combinations
  • Piperacillin/tazobactam
  • Second-generation cephalosporins
  • Carbapenems 1

Treatment Duration:

• Uncomplicated infections: 5-7 days
• Synovitis: 3-4 weeks
• Osteomyelitis: 4-6 weeks 1

Special Considerations

Rabies Prevention:

• Assess rabies risk based on:

  • Vaccination status of the cat
  • Provoked vs. unprovoked attack (unprovoked more concerning)
  • Whether cat can be observed for 10 days 2

• For rabies post-exposure prophylaxis (if indicated):

  • Rabies immune globulin (RIG) - 20 IU/kg body weight
  • Rabies vaccine series (5 doses on days 0,3,7,14, and 28) 2

Tetanus Prophylaxis:

• Administer tetanus toxoid if vaccination status is incomplete or unknown 2

Cat Scratch Disease:

• Consider in patients with persistent lymphadenopathy (especially cervical)
• Caused by Bartonella henselae
• Most cases self-limiting in immunocompetent hosts
• Antibiotics recommended for atypical manifestations 5

Monitoring and Follow-up

• Monitor for signs of infection:

  • Increasing pain, redness, swelling
  • Purulent drainage
  • Fever
  • Lymphangitis

• Higher risk factors for infection:

  • Older patient age
  • Longer time intervals until treatment
  • Deeper wounds
  • Pet cat bites (vs. stray) 3

Complications to Watch For

• Septic arthritis
• Osteomyelitis
• Subcutaneous abscess
• Tendonitis
• Bacteremia 1

Cat bites have particularly high infection rates due to deep puncture wounds and high prevalence of Pasteurella multocida, which can cause rapidly developing cellulitis within 12-24 hours of injury 6. Early recognition and appropriate treatment are essential to prevent serious complications.