What is the treatment for a cat bite?

Treatment of Cat Bites

Amoxicillin-clavulanate is the recommended first-line antibiotic treatment for cat bites due to its effectiveness against Pasteurella multocida and other common pathogens found in cat bite wounds. 1

Initial Management

• Immediate wound cleansing with sterile normal saline irrigation using a 20-mL or larger syringe is essential to reduce bacterial load 2
• Explore the wound for tendon or bone involvement and possible foreign bodies 2
• Debridement of necrotic tissue is crucial for preventing infection 1
• Avoid irrigation under pressure as it may spread bacteria into deeper tissue layers 1
• Consider tetanus prophylaxis status and evaluate the need for rabies prophylaxis 2

Antibiotic Therapy

Oral Treatment Options:

• First-line therapy: Amoxicillin-clavulanate 875/125 mg twice daily (adults) or 25 mg/kg/day of amoxicillin component in 2 divided doses (children) 1
• Alternative options (for penicillin-allergic patients):
  • Doxycycline 100 mg twice daily 1
  • Fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin) plus metronidazole or clindamycin for anaerobic coverage 1

Intravenous Treatment Options (for severe infections):

• β-lactam/β-lactamase combinations (ampicillin-sulbactam) 1
• Piperacillin-tazobactam 1
• Second-generation cephalosporins (cefoxitin) 1
• Carbapenems (ertapenem, imipenem, meropenem) 1

Medications to Avoid:

• First-generation cephalosporins (cephalexin) 1
• Penicillinase-resistant penicillins (dicloxacillin) 1
• Macrolides (erythromycin) 1
• Clindamycin alone (poor activity against P. multocida) 1

Treatment Duration

• For uncomplicated infections: 5-7 days 1
• For deep wounds or high-risk areas (hands, feet, face, genitals, near joints): 10-14 days 1
• For complications like osteomyelitis: 4-6 weeks; for septic arthritis: 3-4 weeks 1

Special Considerations

Microbiology of Cat Bites

• Pasteurella multocida is present in approximately 75% of cat bite wounds 1, 3
• Cat bites contain an average of 5 different bacterial species per wound 1
• Higher prevalence of anaerobes (65%) compared to dog bites (50%) 1
• Common organisms include staphylococci, streptococci, Bacteroides species, Fusobacterium, Porphyromonas, and Prevotella 1, 4

Risk Factors for Infection

• Cat bites have a higher infection rate (30-50%) compared to dog bites (5-25%) 1
• Hand wounds carry the highest risk of infection 5
• Puncture wounds are particularly concerning due to deep inoculation of bacteria 2
• Immunocompromised patients require more aggressive management 1

When to Consider Hospitalization

• Presence of systemic signs of infection (fever, chills) 1
• Severe local inflammation or rapidly spreading cellulitis 6
• Deep wounds involving tendons, joints, or bones 1
• Immunocompromised patients 1
• Failed outpatient therapy 4

Complications to Monitor

• Septic arthritis and osteomyelitis, especially with cat bites to the hand 1
• Tenosynovitis 1
• Abscess formation 4
• Lymphangitis 6
• Rarely, bacteremia and sepsis, particularly in immunocompromised patients or those with asplenia 1