What is the appropriate treatment for a patient bitten by a sick cat with fever, who is currently asymptomatic except for the bite mark?

Cat Bite Management

For a patient bitten by a sick cat with fever, immediately irrigate the wound thoroughly with soap and water for 15 minutes, do NOT close the wound, initiate antibiotic prophylaxis with amoxicillin-clavulanate, and assess for rabies and tetanus prophylaxis. 1

Immediate Wound Care

• Irrigate the wound extensively with soap and water for approximately 15 minutes to reduce infection risk and potential rabies transmission 1
• Consider using povidone-iodine solution as a virucidal agent during irrigation 1
• Examine carefully for tendon, bone, or joint involvement, particularly if pain seems disproportionate to the visible injury 1
• Do NOT close cat bite wounds, especially puncture wounds, as primary closure significantly increases infection risk due to the deep, narrow nature of cat bites 1, 2

Why Not Close Cat Bite Wounds?

Cat bites create deep puncture wounds that trap bacteria (particularly Pasteurella multocida) in tissue, and closure dramatically increases infection rates 3, 4. The decision to suture should only be considered for large lacerations where cosmetic factors are critical, and even then, infection risk must be carefully weighed 1.

Antibiotic Prophylaxis - MANDATORY

All cat bites require antibiotic prophylaxis given the high infection rate (up to 50% of cat bites become infected) 1, 3:

• First-line: Amoxicillin-clavulanate (covers Pasteurella multocida, the pathogen isolated in over half of cat bite wounds) 1, 3, 2
• For penicillin-allergic patients: doxycycline or a fluoroquinolone plus an anaerobic agent 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 IV therapy: β-lactam/β-lactamase combinations, piperacillin-tazobactam, second-generation cephalosporins, or carbapenems 1

Rabies Assessment - CRITICAL Given Sick Cat

This scenario requires urgent rabies risk assessment because the cat is sick with fever 1:

• A sick cat with fever raises significant concern for rabies, especially if behavioral changes are present 1
• The cat must be quarantined and observed for 10 days if possible 1
• If the cat cannot be observed (dies, escapes, or shows neurological signs), rabies postexposure prophylaxis must be initiated immediately with both rabies immune globulin and rabies vaccine 1
• The first dose of vaccine should be given as soon as possible after exposure 1

Common Pitfall:

Do not delay rabies prophylaxis while waiting to "see what happens" with a sick cat. If the animal's health status is uncertain or deteriorating, err on the side of initiating prophylaxis 1.

Tetanus Prophylaxis

• Administer tetanus prophylaxis based on the patient's immunization status 1, 2
• If last tetanus booster was >5 years ago for a contaminated wound, or >10 years for a clean wound, update vaccination 1

High-Risk Features Requiring Heightened Vigilance

Hand wounds have the greatest risk of complications and should always receive aggressive treatment 1, 3:

• Hand bites, particularly over joints, tendons, or bones, can lead to septic arthritis, osteomyelitis, tendonitis, and abscess formation 1
• Immunocompromised patients are at higher risk for severe infections including Capnocytophaga canimorsus bacteremia 1

Answer to Multiple Choice Options

• A) Irrigate with water then close the wound: INCORRECT - Irrigation is correct, but closing cat bite wounds increases infection risk dramatically 1, 2
• B) Rabies or Rubella vaccine: PARTIALLY CORRECT - Rabies assessment is critical given the sick cat, but rubella is irrelevant to animal bites 1
• C) Antibiotics: CORRECT - Antibiotic prophylaxis is mandatory for cat bites 1, 3, 2

The complete answer requires ALL THREE components: thorough irrigation WITHOUT closure, antibiotics (amoxicillin-clavulanate), AND rabies/tetanus assessment 1.