Management of Cat Scratch Without Bleeding
For a cat scratch without bleeding, thoroughly wash the wound with sterile normal saline immediately, then monitor for signs of infection over the next 3-5 days—prophylactic antibiotics are generally not needed for superficial scratches without high-risk features. 1
Immediate Wound Care
- Cleanse the scratch thoroughly with sterile normal saline to remove superficial debris and reduce bacterial load 1
- Deeper debridement is unnecessary for superficial scratches without significant devitalized tissue 1
- Washing should be done promptly after the injury occurs 2
Risk Stratification for Infection
Cat scratches carry approximately 10-20% risk of infection (lower than actual bites at 30-50%) 1. However, prophylactic antibiotics are not routinely indicated for superficial scratches without bleeding unless specific high-risk features are present 1.
High-Risk Features Requiring Prophylactic Antibiotics:
- Deep wounds (even if not actively bleeding) 1
- Location on hands, feet, face, or near joints 1
- Immunocompromised status (HIV/AIDS, diabetes, chronic steroids, chemotherapy) 1
- Significant surrounding tissue damage or crush injury 1
If Prophylactic Antibiotics Are Indicated:
Amoxicillin-clavulanate is first-line therapy, providing coverage against Pasteurella multocida and other common cat-associated pathogens 1. Standard dosing is 875/125 mg twice daily for adults 1.
For penicillin-allergic patients:
- Doxycycline 100 mg twice daily (excellent Pasteurella activity) 1
- Fluoroquinolones: ciprofloxacin 500-750 mg twice daily 1
- TMP-SMZ plus metronidazole (requires combination for anaerobic coverage) 1
Additional Preventive Measures
- Verify tetanus immunization status and update if needed 1
- Assess rabies risk if the cat is unknown, feral, or behaving abnormally 1
- Elevate the affected body part if any swelling develops to accelerate healing 1
Monitoring for Complications
Instruct the patient to return immediately if any of these develop:
- Increasing pain, redness, or swelling 1
- Purulent drainage 1
- Fever 1
- Red streaking up the limb (lymphangitis) 1
- Joint pain or decreased range of motion (especially hand wounds—risk of septic arthritis) 1
Cat Scratch Disease (Bartonella henselae) Awareness
Even superficial scratches can transmit Bartonella henselae, though infection typically requires inoculation through broken skin 3, 4.
Classic presentation develops in stages:
- Papule or pustule at scratch site 3-30 days after injury 3, 4
- Regional lymphadenopathy approximately 3 weeks after inoculation 3, 4
- Lymph nodes generally resolve within 1-6 months 3, 4
If cat scratch disease develops, azithromycin is first-line treatment:
- Adults >45 kg: 500 mg day 1, then 250 mg daily for 4 days 3, 1, 4
- Patients <45 kg: 10 mg/kg day 1, then 5 mg/kg daily for 4 days 3, 1, 4
Special Populations
Immunocompromised patients (particularly HIV with CD4+ <100 cells/µL) require heightened vigilance as they risk developing bacillary angiomatosis, peliosis hepatis, or disseminated disease 2, 4. These patients should receive prophylactic antibiotics even for minor scratches 1.
Diabetic patients require more aggressive treatment if infection develops due to impaired immune response and delayed wound healing 1. Consider 3-4 weeks of antibiotics rather than the standard 1-2 weeks if infection occurs 1.
Pregnant women should use erythromycin if treatment becomes necessary, avoiding tetracyclines completely 2, 4.
Common Pitfalls
- Do not use clindamycin as monotherapy for cat scratches—it lacks adequate Pasteurella coverage despite good activity against staphylococci and streptococci 1
- Penicillins and first-generation cephalosporins have no activity against Bartonella and should not be used if cat scratch disease develops 4
- Do not test the cat for Bartonella infection—this provides no clinical benefit 2, 4
- Avoid rough play with cats to prevent future scratches, and implement flea control measures as fleas transmit Bartonella between cats 2, 4