From the Guidelines
For inpatient treatment of cellulitis due to cat bite and cat scratch, I recommend empiric broad-spectrum antibiotic therapy with ampicillin-sulbactam 3g IV every 6 hours or piperacillin-tazobactam 4.5g IV every 6-8 hours. This recommendation is based on the most recent and highest quality study available, which provides guidelines for the diagnosis and management of skin and soft tissue infections, including those caused by animal bites 1. The chosen antibiotics provide coverage for the common pathogens introduced by cat bites and scratches, including Pasteurella multocida, Streptococcus species, Staphylococcus species, and anaerobes. Alternative regimens, such as a combination of clindamycin and ciprofloxacin or levofloxacin, can be considered for patients with specific allergies or resistance patterns 1. It's also important to note that for patients with penicillin allergy, moxifloxacin or a combination of doxycycline and metronidazole can be used as alternative treatments. Treatment should continue for 10-14 days, with transition to oral antibiotics when clinical improvement occurs. Supportive measures, including wound cleaning, irrigation, and debridement, elevation of the affected limb, pain management, and tetanus prophylaxis, are also crucial in the management of these infections. Close monitoring for signs of deeper infection is essential, particularly for bites over joints or tendon sheaths. In addition to these measures, it's worth noting that cat-scratch disease, caused by Bartonella henselae, may require specific antibiotic treatment, such as penicillin or amoxicillin, for 7-10 days 1. However, the primary focus should be on treating the cellulitis and preventing further complications.
Some key points to consider in the treatment of cellulitis due to cat bite and cat scratch include:
- Coverage for common pathogens, including Pasteurella multocida, Streptococcus species, Staphylococcus species, and anaerobes
- Alternative regimens for patients with specific allergies or resistance patterns
- Supportive measures, including wound cleaning, irrigation, and debridement, elevation of the affected limb, pain management, and tetanus prophylaxis
- Close monitoring for signs of deeper infection, particularly for bites over joints or tendon sheaths
- Consideration of specific antibiotic treatment for cat-scratch disease, if diagnosed.
Overall, the treatment of cellulitis due to cat bite and cat scratch requires a comprehensive approach, including empiric broad-spectrum antibiotic therapy, supportive measures, and close monitoring for complications.
From the Research
Treatment for Inpatient Cellulitis due to Cat Bite and Cat Scratch Disease
- The treatment for inpatient cellulitis due to cat bite and cat scratch disease typically involves the use of intravenous antibiotics 2.
- Pasteurella multocida is a common cause of infection in cat bites, and clinicians should consider this possibility in patients with pet exposure, especially in immunocompromised individuals 2, 3.
- Amoxicillin-clavulanate is recommended for the outpatient treatment of dog and cat bite wounds, but may not be sufficient for inpatient treatment of cellulitis 3.
- For cat-scratch disease, which is caused by Bartonella henselae, treatment with antibiotics such as azithromycin, clarithromycin, or rifampin may be effective 4.
- The majority of non-purulent, uncomplicated cases of cellulitis are caused by β-hemolytic streptococci or methicillin-sensitive Staphylococcus aureus, and appropriate targeted coverage of this pathogen with oral antibiotics such as penicillin, amoxicillin, and cephalexin is sufficient 5.
Antibiotic Treatment
- Intravenous antibiotics are often used to treat inpatient cellulitis, especially in severe cases or in patients with underlying medical conditions 2.
- The choice of antibiotic should be based on the suspected causative organism and the patient's clinical presentation 3, 4, 5.
- In some cases, antibiotic prophylaxis may be effective in preventing recurrent cellulitis 6.