What is the recommended treatment for a cat bite?

Cat Bite Treatment

Cat bites require immediate thorough wound cleansing with soap and water for 15 minutes, followed by prophylactic amoxicillin-clavulanate due to the high risk of infection (20-80% of cat bites become infected compared to only 3-18% of dog bites). 1, 2

Initial Wound Management

• Immediately wash and flush all bite wounds thoroughly with soap and water for approximately 15 minutes to reduce infection risk and potential rabies transmission 3, 4
• Consider using a virucidal agent such as povidone-iodine solution for irrigation 3
• Carefully examine the wound for tendon, bone, or joint involvement, which may be indicated by pain disproportionate to the injury 5
• The decision to suture large wounds should take into account cosmetic factors and the potential for bacterial infection 3, 4
• Cat bite wounds on the hand have the greatest risk of infection and should be treated with special caution 2, 6

Antibiotic Prophylaxis

• Amoxicillin-clavulanate is the first-line prophylactic antibiotic for cat bite wounds due to excellent coverage against Pasteurella multocida (found in over 90% of cats) and other common pathogens 1, 2
• For penicillin-allergic patients, alternative options include doxycycline or a fluoroquinolone plus an agent active against anaerobes 4
• Avoid first-generation cephalosporins, penicillinase-resistant penicillins, macrolides, and clindamycin alone as they have poor activity against Pasteurella multocida 4
• For severe infections requiring intravenous therapy, options include β-lactam/β-lactamase combinations, piperacillin-tazobactam, second-generation cephalosporins, or carbapenems 4

Microbiology of Cat Bite Wounds

• Cat bite wounds are typically polymicrobial with mixed aerobic and anaerobic bacteria 7
• Pasteurella multocida is isolated from over 50% of cat bite wounds and can cause serious infection with severe complications 2, 6
• Other common pathogens include staphylococci, streptococci, and anaerobes such as Bacteroides species, fusobacteria, Porphyromonas species, and peptostreptococci 4, 7

Rabies and Tetanus Prophylaxis

• Assess the need for rabies prophylaxis based on the vaccination status of the cat, circumstances of the bite, and whether the animal can be observed for 10 days 3
• If rabies prophylaxis is indicated, administer both rabies immune globulin and rabies vaccine, with the first dose of vaccine given as soon as possible after exposure 3
• Administer tetanus prophylaxis as indicated based on the patient's immunization status 4, 5

High-Risk Situations Requiring Special Attention

• Hand wounds (particularly over joints, tendons, or bones) have higher risk of complications and should always receive antibiotic prophylaxis 4, 6
• Immunocompromised patients, including those with asplenia or liver disease, are at higher risk for severe infections, including Capnocytophaga canimorsus bacteremia 5, 7
• Potential complications to monitor include septic arthritis, osteomyelitis, subcutaneous abscess formation, tendonitis, and bacteremia 4, 5

Follow-up Care

• Wounds should be reassessed within 24-48 hours, especially if signs of infection develop (increasing pain, redness, swelling, or purulent drainage) 6
• If infection progresses despite appropriate antibiotic therapy, consider surgical drainage and culture-directed antibiotic therapy 6