Cat Bite Treatment
All cat bite wounds should receive immediate thorough irrigation with soap and water for 15 minutes, and most patients should receive prophylactic antibiotics with amoxicillin-clavulanate due to the exceptionally high infection rate of 30-50% and near-universal presence of Pasteurella multocida in feline oral flora. 1, 2
Immediate Wound Management
- Irrigate the wound immediately and thoroughly with soap and water for approximately 15 minutes to reduce both infection risk and potential rabies transmission 1
- Add povidone-iodine solution to the irrigation as a virucidal agent 1
- Carefully examine for tendon, bone, or joint involvement—look specifically for pain disproportionate to the visible injury, which suggests deeper structure involvement 1
- Do not irrigate under high pressure, as this drives bacteria deeper into tissue planes 3
- Debride any necrotic tissue mechanically to reduce pathogen burden 3
Antibiotic Prophylaxis Strategy
Antibiotic prophylaxis is strongly recommended for most cat bites given the 30-50% infection rate, which is substantially higher than dog bites (5-25%) 3
First-Line Antibiotic Choice:
- Amoxicillin-clavulanate is the preferred antibiotic as it covers Pasteurella multocida (present in approximately 90% of cat oral cavities), staphylococci, streptococci, and anaerobes including Bacteroides, Fusobacterium, and Porphyromonas species 1, 2
- Treat for 3-5 days for prophylaxis 3
For Penicillin-Allergic Patients:
- Use doxycycline or a fluoroquinolone plus an agent active against anaerobes (such as metronidazole) 1
Antibiotics to Avoid:
- Never use first-generation cephalosporins, penicillinase-resistant penicillins, macrolides, or clindamycin alone as they have poor activity against Pasteurella multocida 1
Severe Infections Requiring IV Therapy:
- Use β-lactam/β-lactamase combinations, piperacillin-tazobactam, second-generation cephalosporins, or carbapenems 1
High-Risk Wounds Requiring Mandatory Antibiotic Prophylaxis
Always provide antibiotic prophylaxis for:
- Hand wounds, especially those over joints, tendons, or bones—these have the highest complication risk 1, 4
- Deep wounds 3
- Wounds on feet, near joints, face, or genitals 3
- Fresh wounds in critical anatomical locations 3
- Patients with compromised immune status, severe comorbidities, or associated severe cellulitis 3
- Immunocompromised patients, including those with asplenia or liver disease (at higher risk for Capnocytophaga canimorsus bacteremia) 1
Wound Closure Decisions
- Consider primary closure only for facial wounds where cosmetic factors are paramount, and only after thorough irrigation and debridement 1
- For most other locations, avoid primary closure due to high bacterial infection risk 1
- The decision must balance cosmetic outcomes against infection potential 1
Rabies Prophylaxis Assessment
- Assess the cat's vaccination status, circumstances of the bite, and whether the animal can be observed for 10 days 1
- If rabies prophylaxis is indicated, administer both rabies immune globulin and rabies vaccine immediately, with the first vaccine dose given as soon as possible after exposure 1
- Consult local health officials regarding rabies risk in your geographic area 1
Tetanus Prophylaxis
- Administer tetanus prophylaxis based on the patient's immunization status 1
Complications to Monitor
Watch for these serious complications:
- Septic arthritis 1
- Osteomyelitis 1
- Subcutaneous abscess formation 1
- Tendonitis 1
- Bacteremia 1
- Endocarditis in patients with persistent systemic infection signs 3
Common Pitfalls to Avoid
- Do not use universal antibiotic prophylaxis for all bite wounds indiscriminately, but recognize that cat bites are the exception where prophylaxis is nearly always warranted due to the 30-50% infection rate 3
- Do not close hand wounds primarily 1
- Do not use high-pressure irrigation 3
- Do not select antibiotics with poor Pasteurella coverage 1
- Do not delay presentation—wounds presenting >8 hours after injury have higher infection risk 3