What is the most effective antibiotic ointment for treating a cat scratch wound?

From the Guidelines

For treating a cat scratch, azithromycin is the most effective antibiotic, with a recommended dose of 500 mg on day 1, then 250 mg once daily for 4 additional days for patients weighing ≥45.5 kg, as it has been shown to reduce lymph node size by 80% at 30 days in azithromycin-treated patients compared to placebo (1). However, for over-the-counter antibiotic ointments, Neosporin (containing neomycin, polymyxin B, and bacitracin) or Polysporin (containing polymyxin B and bacitracin) are generally considered effective options. Some key points to consider when treating a cat scratch include:

• Thoroughly cleaning the scratch with mild soap and water for at least 20 seconds, then rinsing and patting dry
• Applying a thin layer of antibiotic ointment to the cleaned wound 2-3 times daily and covering with a sterile bandage if needed
• Continuing application for 3-5 days or until the scratch shows signs of healing
• Watching for signs of infection such as increasing redness, swelling, warmth, pus, or red streaks extending from the wound, which would require medical attention
• Considering Polysporin as a better option if skin irritation occurs due to neomycin allergy It's also important to note that while azithromycin has been shown to be effective in treating cat scratch disease, the evidence for other antibiotics is limited, and the decision to administer oral or parenteral antibiotics depends on the depth and severity of the wound and on the time since the bite (1).

From the Research

Treatment of Cat Scratch Disease

When treating a cat scratch, the choice of antibiotic ointment is crucial. According to the studies, the following points should be considered:

• Most cases of cat-scratch disease are self-limited and do not require antibiotic treatment 2
• If an antibiotic is chosen, azithromycin has been shown in one small study to speed recovery 2
• Other antibiotics that have been found to be efficacious in treating cat-scratch disease include:
  • Rifampin (87% effective) 3
  • Ciprofloxacin (84% effective) 3
  • Trimethoprim-sulfamethoxazole (58% effective) 3
  • Gentamicin sulfate (73% effective) 3, 4
• It is essential to note that antibiotic therapy can be considered for patients with severe cat scratch disease, while conservative, symptomatic treatment is recommended for the majority of patients with mild or moderate CSD 3

Key Findings

The key findings from the studies are:

• Cat-scratch disease is usually a benign, self-limited disease that causes regional lymphadenopathy 5, 2
• The causative microorganism, B. henselae, is difficult to culture 2
• Diagnosis is most often arrived at by obtaining a history of exposure to cats and a serologic test with high titers of immunoglobulin G antibody to B. henselae 2
• The disease can be transmitted through cat bites and scratches, and occasionally through arthropod vectors such as fleas or ticks 2