From the Guidelines
Antibiotics are not recommended for an 11-year-old female with a cat scratch injury that was closed with tape, unless signs of infection develop. The management of cat scratch disease, which is typically caused by Bartonella henselae, has variable results with antimicrobial agents, and the use of antibiotics is not routinely recommended for uncomplicated cases 1. However, it is essential to monitor the wound closely for signs of infection, such as increasing redness, warmth, swelling, pus, red streaking, or fever.
- The wound should be cleaned thoroughly with soap and water twice daily, and an antibiotic ointment like Bacitracin or Neosporin should be applied with a clean bandage.
- If signs of infection develop, oral antibiotics like azithromycin may be considered, with a recommended dose of 10 mg/kg orally on day 1, then 5 mg/kg on days 2–5 for patients weighing <45.5 kg 1.
- Additionally, ensuring the patient's tetanus vaccination is up-to-date is crucial in preventing tetanus infection.
- It is also important to note that cat scratches can sometimes lead to infections because cat claws harbor bacteria, particularly Bartonella henselae, and proper wound care and vigilant monitoring are essential to prevent infection 1.
From the Research
Cat Scratch Disease Treatment
- The majority of cases of cat-scratch disease occurring in normal hosts do not require anti-infective therapy for resolution of infection 2.
- Cat-scratch disease is usually a self-limited illness that does not necessarily require antibiotic therapy 3, 4.
- Severe or persistent cases respond well to several antibiotics, including erythromycin, doxycycline, and azithromycin 2, 3, 4.
- Azithromycin has been shown in one small study to speed recovery 4.
Antibiotic Therapy
- Antibiotic therapy is reserved for patients with atypical or severe involvement, including encephalopathy and retinitis 3.
- Gentamicin may be efficacious in shortening the course of cat-scratch disease, but prospective, randomized trials are needed to confirm these results 5.
- For bite wound infections, phenoxymethyl penicillin is recommended as the drug of choice, but ciprofloxacin may be used in case of slow recovery or no improvement 6.
Specific Considerations
- The use of antibiotics in an 11-year-old female with a cat scratch injury that was closed with tape (adhesive dressing) instead of sutures would depend on the severity of the infection and the presence of any underlying medical conditions 2, 3, 4, 5.
- As the majority of cases of cat-scratch disease are self-limited, antibiotic therapy may not be necessary unless the infection is severe or persistent 2, 3, 4.