What is the recommended treatment for a cat bite?

Treatment for Cat Bite

The recommended treatment for a cat bite includes immediate and thorough wound cleansing with soap and water for 15 minutes, followed by prophylactic antibiotic therapy with amoxicillin-clavulanate, assessment for rabies exposure, and tetanus prophylaxis as indicated. 1

Initial Wound Management

• Immediately wash and flush all bite wounds thoroughly with soap and water for about 15 minutes to reduce infection risk and potential rabies transmission 2, 1
• Apply a virucidal agent such as povidone-iodine solution for irrigation after cleaning 2
• Thorough wound cleansing alone has been shown to markedly reduce the likelihood of rabies in animal studies 2
• The decision to suture large wounds should consider cosmetic factors and bacterial infection potential; generally, cat bite wounds should not be sutured due to high infection risk 2, 1

Antibiotic Prophylaxis

• Amoxicillin-clavulanate is the first-line prophylactic antibiotic for cat bite wounds 1, 3
  • Adult dosage: 875/125 mg twice per day orally 2
  • Pediatric dosage: 25 mg/kg/day of the amoxicillin component in 2 divided doses orally 2
• Alternative options for penicillin-allergic patients include:
  • Doxycycline (not recommended for children under 8 years) 1
  • Fluoroquinolone plus an agent active against anaerobes 1
• First-generation cephalosporins, penicillinase-resistant penicillins, macrolides, and clindamycin alone should be avoided due to poor activity against Pasteurella multocida 1

Rationale for Aggressive Treatment

• Cat bites have a significantly higher infection rate (20-80%) compared to dog bites (3-18%) 3, 4
• Pasteurella multocida is found in approximately 90% of domestic cats' oral cavities and is the most common pathogen in infected cat bite wounds 3
• Cat bite wounds on the hand have the greatest risk of infection and potential for serious complications 5, 6, 7
• Risk factors for infection include:
  • Older patient age 6
  • Longer time intervals until treatment 6
  • Deeper wounds, especially puncture wounds 6
  • Lower extremity wounds 6

Rabies Considerations

• Assessment for potential rabies exposure is essential for all cat bites 1
• A healthy domestic cat that bites a person may be confined and observed for 10 days 2
• Any illness in the animal during confinement should be evaluated by a veterinarian and reported to the local public health department 2
• If the biting cat is stray or unwanted, it should either be observed for 10 days or be euthanized immediately and submitted for rabies examination 2
• Rabies post-exposure prophylaxis should be considered based on the circumstances of the bite and the animal's vaccination status 2

Tetanus Prophylaxis

• Administer tetanus prophylaxis as indicated based on the patient's immunization status 2, 1
• For patients with unknown or incomplete tetanus immunization, tetanus toxoid should be administered 1

Special Considerations

• Hand wounds require particularly careful evaluation and treatment due to higher complication rates 1, 7
• Wounds involving joints, tendons, ligaments, or fractures require more aggressive management 1
• Monitor for potential complications including septic arthritis, osteomyelitis, subcutaneous abscess formation, tendonitis, and bacteremia 1
• Pain disproportionate to the severity of injury near a bone or joint may suggest periosteal penetration 1