Is Cubicin (daptomycin) indicated for cat bites?

Cubicin (Daptomycin) is NOT Indicated for Cat Bite Infections

Cubicin (daptomycin) is not recommended for the treatment of cat bite infections as it lacks activity against Pasteurella multocida, the most common pathogen in cat bites. 1, 2

Microbiology of Cat Bite Infections

• Cat bites have a high infection rate (20-80%) with a polymicrobial profile, with Pasteurella multocida present in approximately 75% of cases 2, 3
• The average cat bite wound yields 5 different bacterial isolates, with about 60% containing mixed aerobic and anaerobic bacteria 1
• Staphylococci and streptococci are found in approximately 40% of cat bite wounds 1, 2
• Cat bites have a greater prevalence of anaerobes (65%) compared to dog bites (50%) 1, 2
• Capnocytophaga canimorsus, a fastidious gram-negative rod, can cause bacteremia and fatal sepsis after animal bites, especially in immunocompromised patients 1

Recommended Treatment for Cat Bite Infections

First-Line Therapy

• Amoxicillin-clavulanate (500/875 mg orally twice daily for 7-10 days) is the recommended first-line treatment for cat bite infections 1, 2, 4
• For severe infections requiring intravenous therapy, ampicillin-sulbactam (1.5-3.0 g IV every 6-8 hours) is recommended 1, 2

Alternative Options for Penicillin-Allergic Patients

• Doxycycline (100 mg orally twice daily) has excellent activity against P. multocida and is recommended for patients with penicillin allergy 1, 2
• Other options may include fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin) plus an agent active against anaerobes such as metronidazole 1

Important Considerations and Pitfalls

• First-generation cephalosporins (e.g., cephalexin), penicillinase-resistant penicillins (e.g., dicloxacillin), macrolides (e.g., erythromycin), and clindamycin all have poor in vitro activity against P. multocida and should be avoided 1, 2
• Daptomycin (Cubicin) is not mentioned in any guidelines for cat bite treatment and lacks coverage against the gram-negative organisms commonly found in cat bites 1, 2
• Cat bites have a higher proportion of osteomyelitis and septic arthritis compared to dog bites, requiring vigilant monitoring for these complications 1, 2, 5
• Prophylactic antibiotics are recommended for cat bites even if the external wound appears small, due to the high risk of infection 2, 5

Special Considerations

• Immunocompromised patients or those with underlying hepatic disease are at higher risk for severe infection and may require more aggressive treatment 1, 2
• For suspected Bartonella henselae infection (cat scratch disease), azithromycin may be beneficial (500 mg on day 1, then 250 mg for 4 additional days) 2
• Always assess tetanus immunization status and consider rabies risk when managing cat bite wounds 4, 6

Treatment Algorithm

1. Thoroughly clean the wound with sterile normal saline 2
2. Initiate amoxicillin-clavulanate for empiric therapy 1, 2, 4
3. For penicillin-allergic patients, use doxycycline 1, 2
4. For severe infections requiring hospitalization, use ampicillin-sulbactam IV 1, 2
5. Monitor closely for signs of deep infection, especially with bites to the hand 2, 5
6. Extend antibiotic course to 4-6 weeks if osteomyelitis or septic arthritis develops 2