What is the treatment for a cat scratch?

Treatment for Cat Scratch

The most effective treatment for cat scratches is immediate washing of the wound site with soap and water, followed by azithromycin (500 mg on day 1, then 250 mg for 4 additional days for adults) for cases that develop into cat scratch disease with significant lymphadenopathy. 1

Immediate Care for Cat Scratches

• Promptly wash the site of cat scratches or bites with soap and water to reduce the risk of Bartonella infection 2
• Do not allow cats to lick open wounds or scratches to prevent further contamination 1
• Apply an antiseptic solution to the wound after washing 1
• Monitor the site for signs of infection including redness, swelling, or the development of a papule or pustule 3

When to Suspect Cat Scratch Disease

• A papule or pustule typically develops 3-30 days after a cat scratch or bite 3
• Regional lymphadenopathy usually occurs approximately 3 weeks after the initial scratch 1
• Lymphadenopathy generally resolves within 1-6 months, with suppuration occurring in about 10% of cases 3
• Extranodal disease develops in ≤2% of cases and requires more aggressive treatment 1

Treatment Algorithm for Cat Scratch Disease

For Uncomplicated Cases:

• Most cases of cat scratch disease in immunocompetent patients are self-limited and do not necessarily require antibiotic therapy 4
• Supportive care including analgesics and antipyretics may be sufficient 5

For Moderate to Severe Cases:

• First-line treatment: Azithromycin
  • Adults >45 kg: 500 mg on day 1 followed by 250 mg for 4 additional days 1
  • Children <45 kg: 10 mg/kg on day 1 and 5 mg/kg for 4 more days 1
  • Azithromycin has been shown to more rapidly reduce lymph node size compared to placebo 1

Alternative Treatments (if azithromycin is contraindicated):

• Doxycycline 100 mg twice daily 1
• Erythromycin 500 mg four times daily 1
• Other effective options include ciprofloxacin, trimethoprim-sulfamethoxazole, clarithromycin, rifampin, or gentamicin for severe cases 5

Special Populations

• Pregnant women: Erythromycin is preferred as tetracyclines are contraindicated during pregnancy 1
• Immunocompromised patients: More aggressive and prolonged treatment is needed, particularly for those with HIV who develop bacillary angiomatosis 1
• Patients with atypical presentations: Treatment is strongly recommended for cases with extranodal or disseminated disease 1

Prevention of Cat Scratch Disease

• Implement comprehensive flea control for cats 1
• Avoid rough play with cats and situations where scratches are likely 1
• Consider risks of cat ownership, particularly for severely immunosuppressed persons 1
• Choose cats >1 year old in good health as pets 2
• Keep cats indoors and do not allow them to hunt 2

When to Seek Further Medical Attention

• If lymphadenopathy persists beyond 2-3 months 6
• If systemic symptoms develop including persistent fever, severe headache, or confusion 6
• In cases of ocular involvement, encephalopathy, hepatosplenic infection, or other complications 7

Common Pitfalls

• Failing to consider cat scratch disease in patients with unexplained lymphadenopathy, especially when there is a history of cat exposure 8
• Delaying treatment in immunocompromised patients who are at higher risk for disseminated disease 1
• Not implementing proper wound care immediately after a cat scratch, which is the most important first step in prevention 2