What is the recommended management for a cat bite?

Cat Bite Management

Immediate Wound Care and Antibiotic Therapy

For outpatient management of cat bites, amoxicillin-clavulanate is the first-line antibiotic of choice, and prophylactic antibiotics should be strongly considered for all cat bites given their high infection rate of 30-50%. 1, 2

Initial Wound Management

• Thoroughly irrigate the wound with copious sterile normal saline to remove debris and reduce bacterial load, which is critical for preventing infection 3, 2
• Perform debridement only if significant devitalized tissue is present; most cat bites do not require extensive debridement 2
• Elevate the injured body part, especially if swollen, as this accelerates healing 1, 2

Antibiotic Selection

Oral therapy for outpatients:

• Amoxicillin-clavulanate 875/125 mg twice daily is the recommended first-line agent, providing optimal coverage against Pasteurella multocida (present in 75% of cat bites), anaerobes, staphylococci, and streptococci 1, 2
• For penicillin-allergic patients, doxycycline 100 mg twice daily is an excellent alternative with good Pasteurella activity 1, 2
• Alternative options include fluoroquinolones (ciprofloxacin 500-750 mg twice daily or levofloxacin 750 mg daily) plus metronidazole or clindamycin for anaerobic coverage 1, 2

Intravenous therapy for hospitalized patients:

• Ampicillin-sulbactam, piperacillin-tazobactam, cefoxitin, or carbapenems (ertapenem, imipenem, meropenem) are appropriate options 1

Antibiotics to Avoid

Do not use the following as monotherapy due to poor activity against Pasteurella multocida:

• First-generation cephalosporins (cephalexin)
• Penicillinase-resistant penicillins (dicloxacillin)
• Macrolides (erythromycin)
• Clindamycin alone 1, 2

High-Risk Features Requiring Aggressive Management

When to Prescribe Prophylactic Antibiotics

Prophylactic antibiotics are strongly recommended for:

• All hand wounds (highest risk of infection, osteomyelitis, and septic arthritis) 1, 4, 5
• Deep puncture wounds (most common cat bite type) 1, 4
• Wounds near bones or joints 2
• Wounds on the face or feet 2
• Immunocompromised patients 2
• Presentation >8-12 hours after injury 1

When to Hospitalize and Consider Surgery

Admit for IV antibiotics and surgical consultation if:

• Signs of established infection (purulence, abscess, cellulitis extending beyond wound margins) 1
• Pain disproportionate to injury near a bone or joint, suggesting periosteal penetration, osteomyelitis, or septic arthritis 1, 2
• Deep abscess, extensive necrosis, or signs of necrotizing fasciitis 2
• Hand wounds with any signs of infection require particularly aggressive management 5

Additional Essential Management

Tetanus Prophylaxis

• Assess tetanus immunization status for all patients 3, 2, 6
• Administer tetanus toxoid if not received within the past 10 years 3
• For children, Tdap is preferred if not previously given 3

Rabies Risk Assessment

Initiate rabies post-exposure prophylaxis immediately if:

• The cat is newly adopted with unknown vaccination history and showing abnormal behavior (fever, lethargy, aggression) 3
• The cat is feral, stray, or unavailable for observation 3, 2
• Do not delay rabies prophylaxis while waiting for animal testing results, as rabies is universally fatal once symptoms develop 3

Follow-Up Monitoring

• Instruct patients to return immediately if signs of infection develop: increasing pain, redness, swelling, purulent drainage, or fever 2
• Close follow-up every 1-2 days for the first 5 days is recommended, especially for hand wounds 5
• Monitor for complications including septic arthritis, osteomyelitis, tendonitis, and bacteremia (particularly Capnocytophaga canimorsus in asplenic or cirrhotic patients) 1, 2

Critical Pitfalls to Avoid

• Never assume a cat bite is minor based on appearance alone—cat bites often appear trivial but have infection rates of 30-50%, significantly higher than dog bites (20%) 6, 4, 7
• Hand wounds are particularly dangerous and have the highest risk of serious complications including osteomyelitis and septic arthritis 1, 6, 5
• The absence of redness or swelling at presentation does not rule out serious infection risk or rabies exposure 3
• Puncture wounds and deeper wounds carry the highest infection risk regardless of antibiotic prophylaxis 4
• Cat bites have a higher prevalence of P. multocida (75%) and anaerobes (65%) compared to dog bites, making appropriate antibiotic selection critical 1