What is the treatment for a cat bite?

Cat Bite Treatment Protocol

Cat bites require immediate antibiotic prophylaxis with amoxicillin-clavulanate due to the high risk of infection (15-80% of cat bites become infected) and the prevalence of Pasteurella multocida in feline oral flora. 1, 2

Initial Wound Management

• Immediately wash and flush the wound thoroughly with soap and water for approximately 15 minutes to reduce infection risk 3
• Carefully examine the wound for:
  • Tendon or bone involvement 3
  • Joint penetration (indicated by pain disproportionate to injury near a bone or joint) 3, 4
  • Depth of penetration (cat bites typically cause deep puncture wounds) 5

Antibiotic Therapy

• Amoxicillin-clavulanate is the first-line prophylactic antibiotic for cat bite wounds due to its effectiveness against Pasteurella multocida (found in ~90% of cats) 4, 1
• Alternative oral agents for penicillin-allergic patients include:
  • Doxycycline 4
  • Fluoroquinolone plus an agent active against anaerobes 4
  • Clindamycin plus a fluoroquinolone 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
  • Carbapenems 4

Wound Closure Considerations

• The decision to suture cat bite wounds should consider:
  • Cosmetic factors (facial wounds may be closed if seen early and properly cleaned) 3
  • Risk of infection (cat bites have higher infection rates than dog bites) 1, 2
  • Timing of the wound (fresh wounds are safer to close) 3
• Hand wounds have the greatest risk of infection and should generally be left open 6

Tetanus Prophylaxis

• Assess tetanus immunization status and administer tetanus prophylaxis as indicated 3, 4
• Tetanus toxoid should be given to patients with unknown or incomplete tetanus immunization 3

Rabies Considerations

• Assess the need for rabies prophylaxis based on:
  • Vaccination status of the cat
  • Circumstances of the bite
  • Whether the cat 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

Risk Factors for Infection

• Factors associated with increased infection risk include:
  • Hand location (highest risk) 6
  • Puncture wounds 6
  • Deeper wounds 6
  • Longer time intervals until treatment 6
  • Older patient age 6
  • Wounds from "pet" cats rather than strays 6

Potential Complications to Monitor

• Infectious complications include:
  • Septic arthritis
  • Osteomyelitis
  • Subcutaneous abscess formation
  • Tendonitis
  • Bacteremia 3, 4
• Cat bite infections are typically polymicrobial with mixed aerobic and anaerobic bacteria 2

Follow-up

• Instruct patients to seek immediate medical attention if signs of infection develop (increasing pain, redness, swelling, warmth, purulent drainage, fever) 5
• Consider earlier follow-up (24-48 hours) for high-risk wounds such as those on the hand 6