What is the recommended treatment for a cat scratch?

Treatment of Cat Scratches

For a simple cat scratch, thorough cleaning of the wound with soap and water is the primary recommended treatment to prevent infection. 1

Initial Management of Cat Scratches

• Promptly wash the site of the cat scratch thoroughly with soap and water to reduce the risk of Bartonella infection 2, 1
• Do not allow cats to lick open wounds or cuts to prevent further contamination 2, 1
• Monitor the scratch site for signs of infection such as increasing redness, swelling, warmth, or pain 1

When to Consider Antibiotic Treatment

• Most uncomplicated cat scratches do not require antibiotic therapy as they are typically self-limited 3, 4
• Antibiotic treatment should be considered in the following situations:
  • Development of regional lymphadenopathy (cat scratch disease) 1
  • Signs of progressive local infection 2
  • Immunocompromised patients 1, 5
  • Presence of systemic symptoms such as fever 4

Antibiotic Options for Cat Scratch Disease

• Azithromycin is the first-line treatment for cat scratch disease when antibiotics are indicated (500 mg on day 1, followed by 250 mg for 4 additional days for adults >45 kg) 1, 4
• Alternative treatments if azithromycin is contraindicated:
  • Doxycycline 100 mg twice daily 1
  • Erythromycin 500 mg four times daily 1
  • For severe cases: trimethoprim-sulfamethoxazole, ciprofloxacin, or rifampin 5

Special Considerations

• For children: Weight-based dosing of azithromycin (10 mg/kg on day 1, then 5 mg/kg for 4 more days) 1
• For pregnant women: Erythromycin is preferred as tetracyclines are contraindicated during pregnancy 1
• For immunocompromised patients: More aggressive and prolonged treatment may be necessary, particularly for disseminated disease 1, 6

Prevention of Future Cat Scratches

• Avoid rough play with cats and situations where scratches are likely 2, 1
• Consider risks of cat ownership, particularly for severely immunosuppressed persons 2, 1
• Implement comprehensive flea control for cats to reduce the risk of Bartonella infection 2, 1
• When obtaining a new cat, choose one >1 year old in good health 2, 1

Monitoring and Follow-up

• Most uncomplicated cat scratches heal without complications 3, 4
• If lymphadenopathy develops, it typically resolves within 1-6 months 1
• Seek medical attention if symptoms worsen or if systemic symptoms develop 4, 6
• For recurrent or relapsing Bartonella infection, long-term suppression with erythromycin or doxycycline may be considered 1

Potential Complications to Watch For

• Regional lymphadenopathy (hallmark of cat scratch disease) 1, 4
• Suppuration of lymph nodes (occurs in approximately 10% of cases) 1
• Rare extranodal manifestations (<2% of cases) including hepatosplenic involvement, neuroretinitis, encephalopathy, or osteomyelitis 1, 6
• Bacillary angiomatosis in immunocompromised patients, particularly those with HIV 3, 5