What is the treatment for a cat bite?

Cat Bite Treatment

Cat bites require immediate thorough wound cleansing with soap and water for 15 minutes, and prophylactic antibiotics with amoxicillin-clavulanate should be strongly considered given the high infection rate of 30-50%. 1, 2

Immediate Wound Management

• Irrigate the wound thoroughly with soap and water for approximately 15 minutes to reduce infection risk and potential rabies transmission 2
• Follow soap and water cleansing with povidone-iodine solution irrigation, as this virucidal agent further reduces rabies risk 2
• Carefully examine the wound for depth, tendon involvement, bone involvement, or joint penetration—hand wounds and wounds near joints require particular attention as they carry the highest infection risk 2, 3
• Pain disproportionate to injury severity near a bone or joint may indicate periosteal penetration 4
• Do not suture cat bite wounds routinely—the puncture nature of cat bites creates deep inoculation of bacteria, making primary closure risky except for facial wounds seen early with proper cleaning 1

Antibiotic Prophylaxis

Amoxicillin-clavulanate is the first-line prophylactic antibiotic for cat bite wounds and should be given for 3-5 days, particularly for hand wounds, deep puncture wounds, and wounds near joints 4, 2, 5

• For penicillin-allergic patients, use doxycycline or a fluoroquinolone plus an agent active against anaerobes (such as metronidazole) 4, 5
• Avoid first-generation cephalosporins, penicillinase-resistant penicillins, macrolides, and clindamycin alone—these have poor activity against Pasteurella multocida, which is isolated in over 50% of cat bite wounds 5, 6
• For severe established infections requiring hospitalization, use intravenous β-lactam/β-lactamase combinations, piperacillin-tazobactam, second-generation cephalosporins, or carbapenems 5

High-Risk Scenarios Requiring Antibiotic Prophylaxis

The infection rate for cat bites is double that of dog bites at 30-50%, making prophylaxis particularly important 1, 7

• All hand wounds (highest infection risk) 3
• All puncture wounds (most common cat bite type, creating deep bacterial inoculation) 3
• Wounds involving joints, tendons, ligaments, or bones 5
• Immunocompromised patients 1
• Wounds presenting >8 hours after injury 3
• Deep full-thickness wounds 3

Tetanus Prophylaxis

• Assess tetanus immunization status and administer tetanus toxoid to patients with unknown or incomplete tetanus immunization 2
• Give tetanus prophylaxis as indicated based on standard wound management protocols 2

Rabies Post-Exposure Prophylaxis Decision Algorithm

More cats than dogs are reported rabid in the United States, making rabies assessment critical 2

If the cat is healthy, domestic, and available:

• Confine and observe the cat for 10 days without initiating prophylaxis if the cat is properly vaccinated 2
• Do not initiate unnecessary post-exposure prophylaxis for healthy domestic cats that can be observed 2

Initiate immediate rabies post-exposure prophylaxis if:

• The cat is stray or unwanted and cannot be confined for observation 2
• The cat dies or develops illness before completing the 10-day observation period 2
• The cat shows signs suggestive of rabies during observation 2
• Unprovoked attacks are more likely to indicate rabies than provoked attacks 2

Rabies prophylaxis regimen:

• Administer both Rabies Immune Globulin (RIG) and a 4-5 dose vaccine series for previously unvaccinated persons 2
• Give the first dose of vaccine as soon as possible after exposure 4
• Do not exceed the recommended RIG dose, as excess can suppress active antibody production 2

Critical Pitfalls to Avoid

• Never delay wound cleansing—thorough wound cleansing alone has been shown to markedly reduce rabies likelihood in animal studies 2
• Do not underestimate cat bites as "minor"—they have the highest infection rate among animal bites due to their puncture nature creating deep bacterial inoculation 6, 3
• Hand wounds from cat bites have the greatest risk of infection and can lead to serious complications including septic arthritis and osteomyelitis 6, 3
• Avoid prescribing inadequate antibiotic coverage—Pasteurella multocida is present in over 50% of cat bite wounds and requires specific coverage 6

Potential Infectious Complications to Monitor

• Septic arthritis, osteomyelitis, subcutaneous abscess formation, tendonitis, and bacteremia 2
• Pasteurella multocida can cause serious infection with severe complications including sepsis, particularly in elderly or immunocompromised patients 8
• Wound infections are more likely in older patients, those with longer time intervals until treatment, deeper wounds, and puncture wounds 3
• Patients should be instructed to return immediately for signs of infection: increasing pain, redness, swelling, purulent drainage, fever, or red streaking 3