Is antiretroviral (ARV) therapy needed for a cat bite?

Antiretroviral (ARV) Therapy is NOT Needed for Cat Bites

No, antiretroviral (ARV) therapy is not indicated for cat bites. You need rabies prophylaxis (not ARV), antibiotics, and tetanus prophylaxis. The question appears to confuse antiretroviral therapy (used for HIV) with antirabies vaccination.

What You Actually Need for Cat Bites

Immediate Rabies Risk Assessment

• A healthy domestic cat that bites should be confined and observed for 10 days 1, 2
• If the cat remains healthy during this observation period, no rabies prophylaxis is needed 1
• If the cat cannot be observed (stray, unwanted, or escapes), or develops signs of illness, initiate rabies postexposure prophylaxis immediately 1, 2
• A fully vaccinated cat (with at least two doses) is extremely unlikely to have rabies 1

Rabies Postexposure Prophylaxis (When Indicated)

If rabies prophylaxis is needed, administer both rabies immune globulin (RIG) and rabies vaccine 1, 2:

• Give RIG once at the beginning of treatment (infiltrate around the wound if anatomically feasible, give remainder intramuscularly) 1
• Administer five doses of rabies vaccine intramuscularly on days 0,3,7,14, and 28 1
• Give the first dose as soon as possible after exposure, ideally within 24 hours 1

Immediate Wound Management (Always Required)

• Wash the wound thoroughly with soap and water for 15 minutes immediately 2
• Consider irrigation with povidone-iodine solution as a virucidal agent 1, 2
• Examine carefully for tendon, bone, or joint involvement 2
• Avoid suturing cat bite wounds unless absolutely necessary for cosmetic reasons, as closure increases infection risk 1, 2

Antibiotic Prophylaxis (Critical for Cat Bites)

Cat bites have a 20-80% infection rate—much higher than dog bites—so antibiotic prophylaxis is essential 3, 4, 5:

• First-line: Amoxicillin-clavulanate (covers Pasteurella multocida, the most common pathogen in 75-90% of cat bites) 2, 4
• For penicillin allergy: Doxycycline or a fluoroquinolone plus metronidazole 2
• Avoid first-generation cephalosporins, macrolides, or clindamycin alone—they have poor activity against Pasteurella 2

Tetanus Prophylaxis

• Administer tetanus toxoid based on the patient's immunization history 2

High-Risk Situations Requiring Extra Vigilance

• Hand wounds (especially over joints, tendons, or bones) have the highest complication rates and always require antibiotics 2, 5
• Puncture wounds are deeper than they appear and have higher infection rates 5
• Immunocompromised patients (asplenia, liver disease) are at risk for severe Capnocytophaga canimorsus sepsis 2, 6
• Wounds presenting >8-12 hours after injury have significantly higher infection rates 5

Common Pitfall to Avoid

The term "ARV" in the context of animal bites refers to antirabies vaccination, not antiretroviral therapy for HIV. Cat bites cannot transmit HIV. The confusion likely stems from the abbreviation—always clarify whether rabies prophylaxis is indicated based on the observation status and vaccination history of the cat.