Treatment for Cat Bite
Immediate treatment for cat bites should include thorough wound cleaning with soap and water for 15 minutes, followed by antibiotic prophylaxis with amoxicillin-clavulanate as first-line therapy due to the high risk of infection. 1
Initial Wound Management
- Immediately wash and flush the bite wound thoroughly with soap and water for approximately 15 minutes to reduce infection risk and potential rabies transmission 1
- Consider using povidone-iodine solution for wound irrigation to provide additional antimicrobial action 1
- Carefully examine the wound for tendon, bone, or joint involvement, which may be indicated by pain disproportionate to the injury 1
- Large wounds may require suturing, but this decision must balance cosmetic factors against the increased risk of infection with closed wounds 1
Antibiotic Therapy
- Amoxicillin-clavulanate is the first-line antibiotic for cat bite prophylaxis and treatment due to its excellent coverage against Pasteurella multocida (found in ~90% of cat bites) and other common pathogens 1, 2
- For penicillin-allergic patients, alternative options include doxycycline or a fluoroquinolone plus an agent active against anaerobes 1
- Avoid first-generation cephalosporins, penicillinase-resistant penicillins, macrolides, and clindamycin alone as they have 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
High-Risk Situations Requiring Special Attention
- Cat bites have a significantly higher infection rate (20-80%) compared to dog bites (3-18%), making antibiotic prophylaxis particularly important 2, 3
- Hand wounds (particularly over joints, tendons, or bones) have the highest risk of complications and should always receive antibiotic prophylaxis 1, 3
- Immunocompromised patients, including those with asplenia or liver disease, are at higher risk for severe infections and bacteremia 1
- Potential complications to monitor include septic arthritis, osteomyelitis, subcutaneous abscess formation, tendonitis, and bacteremia 1
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 1
- 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 1
- Administer tetanus prophylaxis as indicated based on the patient's immunization status 1, 3
Microbiology and Antibiotic Selection Rationale
- Pasteurella multocida is the most commonly cultured bacterium from infected cat bite wounds, present in approximately 90% of domestic cats' oral cavities 2
- Other common pathogens include staphylococci, streptococci, and anaerobes such as Bacteroides species, fusobacteria, Porphyromonas species, and peptostreptococci 1
- Studies show high antibiotic susceptibility percentages for amoxicillin-clavulanate (100%), benzylpenicillin (100%), cefazolin (98.37%), and azithromycin (94.02%) against P. multocida isolates 2
- Despite concerns about antibiotic resistance, penicillin and its derivatives remain reliable choices for preventing and treating P. multocida infections 2