What is the treatment for a cat bite?

Treatment of Cat Bites

Cat bites require immediate thorough wound cleaning with soap and water, followed by antibiotic prophylaxis with amoxicillin-clavulanate to prevent infection, particularly for hand wounds which have the highest infection risk. 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 3, 1
• Carefully examine wounds for tendon, bone, or joint involvement, which may be indicated by pain disproportionate to the injury 3, 1
• Cat bites typically cause deeper puncture-type wounds compared to dog bites, which increases infection risk 2
• Remove any foreign bodies and devitalized tissue 2
• Document neurovascular function (pulses, sensation) and range of movement of adjacent joints 2

Antibiotic Prophylaxis

• Amoxicillin-clavulanate is the first-line prophylactic antibiotic for cat bite wounds 1, 2
• Alternative options for penicillin-allergic patients include:
  • Doxycycline 1
  • Fluoroquinolone plus an agent active against anaerobes 1
  • Clindamycin plus a fluoroquinolone 3
• First-generation cephalosporins, penicillinase-resistant penicillins, macrolides, and clindamycin alone should be avoided due to poor activity against Pasteurella multocida 1
• For severe infections requiring intravenous therapy, options include β-lactam/β-lactamase combinations, piperacillin-tazobactam, second-generation cephalosporins, or carbapenems 1

Special Considerations for Cat Bites

• Cat bites have double the infection risk compared to dog bites 4
• Hand wounds from cat bites have the greatest risk of infection 5
• Pasteurella multocida is isolated in over 50% of cat bite wounds and can cause serious infection with severe complications 5
• Cat bites may lead to Bartonella infection (cat-scratch disease) 6
• Puncture wounds and deeper wounds have significantly higher infection rates 7

Wound Closure Considerations

• Primary closure of bite wounds may be performed if there is low risk of infection 2
• Consider cosmetic factors when deciding whether to suture wounds, particularly facial wounds 3, 1
• Deep puncture wounds typical of cat bites generally should not be sutured due to high infection risk 2

Additional Prophylaxis

• Assess tetanus immunization status and administer tetanus prophylaxis as indicated 1, 5
• Evaluate the need for rabies postexposure prophylaxis based on the vaccination status of the cat and circumstances of the bite 3
• If rabies prophylaxis is indicated, administer both rabies immune globulin and rabies vaccine 3

Monitoring for Complications

• Watch for infectious complications including septic arthritis, osteomyelitis, subcutaneous abscess formation, tendonitis, and bacteremia 3, 1
• Cat bite wounds are typically polymicrobial with mixed aerobic and anaerobic bacteria 1
• Common pathogens include Pasteurella species, staphylococci, streptococci, and various anaerobes 1, 4
• Bartonella henselae infection (cat-scratch disease) is a potential complication specific to cat bites and scratches 6