What is the treatment for a cat bite?

Treatment for Cat Bites

Cat bites require immediate wound cleansing with soap and water for 15 minutes, followed by prophylactic antibiotics with amoxicillin-clavulanate as first-line therapy to prevent infection. 1, 2

Initial Wound Management

• Immediately wash and flush the bite wound thoroughly with soap and water for approximately 15 minutes to reduce infection risk 3, 1
• Consider using povidone-iodine solution for wound irrigation if available 4
• Examine the wound carefully for depth, tendon involvement, or potential joint penetration 1
• Pain disproportionate to injury near a bone or joint may suggest periosteal penetration 1
• Remove any foreign bodies and devitalized tissue 2

Antibiotic Prophylaxis

• Amoxicillin-clavulanate is the first-line prophylactic antibiotic for cat bite wounds 3, 1, 2
• Cat bites have double the infection risk compared to dog bites, with approximately 15.6% becoming infected 5, 6
• Alternative oral agents for penicillin-allergic patients include:
  • Doxycycline 3, 1
  • Fluoroquinolone plus an agent active against anaerobes 3, 1
  • Clindamycin plus a fluoroquinolone 3, 1
• First-generation cephalosporins, penicillinase-resistant penicillins, macrolides, and clindamycin alone should be avoided due to poor activity against Pasteurella multocida 1, 7

Risk Factors for Infection

• Cat bite wounds on the hand have the greatest risk of infection 7, 6
• Deeper puncture wounds are more likely to become infected 6
• Delayed presentation (>24 hours) significantly increases infection risk 6, 8
• Pasteurella multocida is isolated in over 50% of cat bite wounds and can cause serious infection with severe complications 7, 5

Wound Closure Considerations

• The decision to suture wounds should consider cosmetic factors and infection risk 3, 1
• Facial wounds may be closed if seen early and properly cleaned 3
• For hand wounds or deep punctures, delayed primary closure may be preferable due to higher infection risk 6, 8

Tetanus and Rabies Prophylaxis

• Assess tetanus immunization status and administer tetanus prophylaxis as indicated 3, 1, 2
• Evaluate the need for rabies prophylaxis based on the vaccination status of the cat, circumstances of the bite, and whether the cat can be observed for 10 days 3, 4
• If rabies prophylaxis is indicated, administer both rabies immune globulin and rabies vaccine 3

Monitoring for Complications

• Monitor for signs of infection including increasing redness, swelling, warmth, pain, purulent discharge, or fever 4
• Potential complications include:
  • Septic arthritis 3, 1
  • Osteomyelitis 3, 1
  • Subcutaneous abscess formation 3, 1
  • Tendonitis or tenosynovitis 3, 8
  • Bacteremia (rare) 1
• Patients with signs of infection, especially involving the hand, may require hospitalization and surgical intervention 8