What is the recommended dose and duration of Augmentin (amoxicillin/clavulanate) for a cat bite?

Augmentin Dosing and Duration for Cat Bites

For cat bites, prescribe amoxicillin-clavulanate (Augmentin) 875/125 mg orally twice daily for 3-5 days for prophylaxis of uncomplicated wounds, or 7-10 days if signs of infection are already present. 1, 2

Dosing Recommendations

Standard Adult Dosing

• Amoxicillin-clavulanate 875/125 mg orally twice daily is the definitive first-line choice, providing optimal coverage against Pasteurella multocida (present in >50% of cat bite wounds), staphylococci, streptococci, and anaerobes 1, 2, 3
• The FDA-approved dosing for more severe infections is one 875/125 mg tablet every 12 hours 4
• Take at the start of meals to enhance absorption of clavulanate and minimize gastrointestinal side effects 4

Alternative Dosing

• For less severe infections, 500/125 mg every 12 hours or 250/125 mg every 8 hours may be used 4
• Do not substitute two 250/125 mg tablets for one 500/125 mg tablet - they contain the same amount of clavulanic acid (125 mg) and are not equivalent 4

Duration of Therapy

Prophylaxis (Fresh Wounds)

• 3-5 days for uncomplicated wounds without signs of infection 1
• Prophylaxis is indicated for deep puncture wounds, wounds on hands/feet/face/near joints, immunocompromised patients, or wounds presenting >8-12 hours after injury 1

Treatment (Established Infection)

• 7-10 days for uncomplicated cellulitis or soft tissue infection 2
• 7-14 days if early signs of infection are present at initial evaluation 1
• For deep tissue involvement requiring IV therapy: 3-5 days IV followed by oral amoxicillin-clavulanate to complete the course 2

Critical Pitfalls to Avoid

• Never use first-generation cephalosporins (cephalexin), penicillinase-resistant penicillins (dicloxacillin), or clindamycin alone - they have poor or absent activity against P. multocida 1, 2
• Cat bites have a 30-50% infection rate, significantly higher than dog bites 5
• Hand wounds carry the highest risk of infection and complications (tendosynovitis, septic arthritis, osteomyelitis) and warrant aggressive treatment 1, 2, 3
• Average cat bite wounds yield 5 different bacterial isolates with 60% having mixed aerobic-anaerobic bacteria 2

Penicillin Allergy Alternatives

Mild Allergy

• Doxycycline 100 mg twice daily for 7-10 days (excellent P. multocida activity) 1, 2

Severe Allergy

• Fluoroquinolone: ciprofloxacin 500-750 mg twice daily or levofloxacin 750 mg daily for 7-10 days 1, 2
• Trimethoprim-sulfamethoxazole plus metronidazole for 7-10 days 1

When to Escalate to IV Therapy

• Systemic signs (fever, lymphangitis, significant cellulitis) 2
• Deep tissue involvement 2
• Immunocompromised patients with moderate-to-severe injury 1
• First-line IV: ampicillin-sulbactam 1.5-3.0 g every 6-8 hours 1, 2

Essential Adjunctive Measures

• Thorough wound irrigation with sterile normal saline 1
• Evaluate tetanus immunization status 1, 5
• Assess rabies risk 1, 5
• Elevate affected extremity 1
• Avoid primary closure of puncture wounds 1

Red Flags Requiring Immediate Return

• Increasing pain, redness, or swelling 1, 2
• Purulent drainage 1
• Fever 1
• Decreased range of motion 1