What is the recommended treatment for a cat scratch?

Treatment for Cat Scratch

For a cat scratch, the recommended treatment is prompt washing of the wound site with soap and water to reduce the risk of Bartonella infection. 1

Initial Management

• Immediately clean the cat scratch thoroughly with soap and water 1
• Do not allow cats to lick open wounds or cuts to prevent further contamination 1
• Monitor the scratch site for signs of infection such as redness, swelling, or pustule formation 2

When to Consider Antibiotic Treatment

Most cat scratches do not require antibiotic therapy as infections are typically self-limited 3, 4. However, antibiotics should be considered in the following situations:

• If signs of infection develop (increasing redness, warmth, swelling, lymphadenopathy) 5
• For immunocompromised individuals who are at higher risk for complications 1, 5
• If ascending lymphangitis develops 5

Antibiotic Options When Needed

If antibiotic treatment is warranted:

• Azithromycin is the preferred treatment (500 mg on day 1, followed by 250 mg for 4 additional days for adults; for children <45 kg: 10 mg/kg on day 1 and 5 mg/kg for 4 more days) 2, 5, 4
• Alternative options include:
  • Doxycycline 100 mg twice daily (not for children under 8 or pregnant women) 5, 6
  • Amoxicillin-clavulanate 500/875 mg twice daily for 7-10 days (especially if polymicrobial infection is suspected) 5
  • Erythromycin for pregnant women or when azithromycin is not available 1, 6

Special Considerations

• Avoid first-generation cephalosporins as they have poor activity against Pasteurella multocida, a common pathogen in cat bite/scratch wounds 5
• For immunocompromised patients (especially HIV-infected):
  • More aggressive evaluation and treatment may be needed 1
  • Long-term suppression with erythromycin or doxycycline should be considered if there is relapse or reinfection 1
• Cat scratch disease typically presents with a papule or pustule 3-30 days after the scratch, followed by regional lymphadenopathy about 3 weeks later 2

Prevention of Future Cat Scratches

• Avoid rough play with cats 1
• Implement proper flea control for cats 1
• Consider adopting cats older than 1 year of age, as they pose less risk 1
• Although declawing is not generally recommended, immunocompromised individuals should be particularly careful to avoid situations where scratches might occur 1

When to Seek Medical Attention

• If fever, severe pain, or spreading redness develops 2, 4
• If lymph nodes become enlarged or tender 2, 4
• If symptoms persist beyond 2 weeks 4, 7
• If the person scratched is immunocompromised 1, 5