What is the recommended treatment for a scratch?

Treatment for a Scratch

For simple, clean scratches, clean the wound with water or saline, apply a thin layer of petrolatum-based ointment (such as Aquaphor) or topical antibiotic ointment (such as bacitracin or Neosporin) 1-3 times daily, and cover with a sterile bandage if desired. 1, 2

Initial Wound Care

All scratches require thorough cleansing as the first and most critical step:

• Clean the affected area with water or sterile normal saline to remove superficial debris and contaminants 3
• Gentle cleansing is sufficient for most superficial scratches; deeper debridement is usually unnecessary unless there is significant devitalized tissue 3
• Pat dry with a clean towel before applying any topical treatment 4

Topical Treatment Options

You have two equally effective options for routine scratch care:

Option 1: Petrolatum-Based Ointment (Preferred for simplicity)

• Apply a small amount (equal to the surface area of a fingertip) of petrolatum-based ointment like Aquaphor 1-3 times daily 1, 2
• Research demonstrates that petrolatum-based ointments provide equivalent wound healing to antibiotic ointments without the risk of allergic contact dermatitis or antibiotic resistance 5, 6
• This approach avoids unnecessary antibiotic exposure for clean, minor wounds 5

Option 2: Topical Antibiotic Ointment

• Apply bacitracin, Neosporin, or Polysporin (amount equal to fingertip surface area) 1-3 times daily 1, 2, 1
• FDA-approved for first aid to help prevent infection in minor cuts, scrapes, and burns 1
• May be covered with a sterile bandage 1, 2

Important caveat: Topical antibiotics carry a small risk of allergic contact dermatitis and may contribute to antibiotic resistance, so petrolatum-based products are increasingly preferred for routine minor wounds 5, 6

When Systemic Antibiotics ARE Indicated

Prophylactic oral antibiotics are necessary for scratches that meet ANY of these criteria:

• Cat or animal scratches that are deep, on the hands, feet, face, or near joints 3
• Scratches in immunocompromised patients 3
• Scratches with significant tissue damage or devitalized tissue 3

For these high-risk scratches, use amoxicillin-clavulanate as first-line therapy to provide coverage against Pasteurella multocida and other common pathogens 3

Alternative regimens for penicillin allergy:

• Doxycycline 100 mg twice daily (adults) 3
• Trimethoprim-sulfamethoxazole plus metronidazole 3
• Fluoroquinolones (ciprofloxacin 500-750 mg twice daily) 3

Tetanus Prophylaxis

Update tetanus immunization based on wound type and vaccination history:

• For clean scratches: Give tetanus booster if >10 years since last dose 4
• For dirty/contaminated scratches: Give tetanus booster if >5 years since last dose 4
• Tdap is preferred over Td if the patient has not previously received Tdap 4
• Complete the primary vaccine series if not previously done 4

Special Consideration: Cat Scratch Disease

If a cat scratch develops into cat scratch disease (papule/pustule at scratch site followed by regional lymphadenopathy 3 weeks later), treat with azithromycin:

• Patients >45 kg: 500 mg on day 1, then 250 mg daily for 4 additional days 4, 7
• Patients <45 kg: 10 mg/kg on day 1, then 5 mg/kg daily for 4 additional days 4, 7

Follow-Up Instructions

Advise patients to return if any signs of infection develop:

• Increasing pain, redness, or swelling 3
• Purulent drainage 3
• Fever 3
• Red streaking from the wound 3

For hand scratches specifically, monitor closely for complications such as septic arthritis, osteomyelitis, or tendonitis 3