From the Guidelines
Cat bites typically require antibiotic treatment due to the high risk of infection, and the recommended first-line antibiotic is amoxicillin-clavulanate (Augmentin), usually prescribed at 875/125 mg taken orally twice daily for 5-7 days. The choice of antibiotic is crucial in managing cat bite infections, as cat mouths contain numerous bacteria including Pasteurella multocida, which can cause rapid infection within 24-48 hours 1. According to the practice guidelines for the diagnosis and management of skin and soft tissue infections, amoxicillin-clavulanate is the preferred treatment option due to its broad-spectrum activity against both aerobic and anaerobic bacteria, including Pasteurella multocida 1.
For patients with penicillin allergies, alternatives include doxycycline (100 mg twice daily), trimethoprim-sulfamethoxazole plus clindamycin, or a fluoroquinolone like ciprofloxacin 1. It is essential to note that first-generation cephalosporins, such as cephalexin, penicillinase-resistant penicillins (e.g., dicloxacillin), macrolides (e.g., erythromycin), and clindamycin, all have poor in vitro activity against P. multocida and should be avoided 1.
In addition to antibiotics, the wound should be thoroughly cleaned with soap and water, and tetanus prophylaxis should be considered if the patient's immunization is not current. Cat bites are particularly concerning because their sharp, narrow teeth can create deep puncture wounds that are difficult to clean and create an ideal environment for bacteria to flourish. Severe or deep bites, especially on hands, joints, or face, may require hospitalization for intravenous antibiotics. Any signs of worsening infection such as increasing redness, swelling, warmth, pus, or fever should prompt immediate medical attention.
Key considerations in managing cat bite infections include:
- Prompt initiation of antibiotic treatment
- Thorough wound cleaning and tetanus prophylaxis
- Monitoring for signs of worsening infection
- Consideration of hospitalization for severe or deep bites
- Avoidance of first-generation cephalosporins and other ineffective antibiotics against P. multocida 1.
From the Research
Cat Bite Antibiotic Treatment
- Cat bites can lead to serious infections, with Pasteurella multocida being a common cause of infection, found in over half of all cat bite wounds 2.
- The risk of infection is particularly high for cat bite wounds on the hand 2.
- Amoxicillin-clavulanate is recommended for the outpatient treatment of dog and cat bite wounds, including those caused by Pasteurella multocida 2, 3.
- Alternative oral agents to penicillins, such as cefprozil, cefuroxime, and trimethoprim/sulfamethoxazole, may also be effective against Pasteurella multocida infections 3.
- Amoxicillin-clavulanic acid is a commonly used combination for empiric therapy, but its use should be guided by epidemiological and pharmacokinetic data to minimize the risk of resistance and side effects 4.
Antibiotic Options
- Amoxicillin is a widely used penicillin for treating various infections, including those caused by Pasteurella multocida 4.
- Clavulanic acid is often combined with amoxicillin to enhance its effectiveness against beta-lactamase-producing bacteria, but it can also increase the risk of gastrointestinal side effects 4.
- The choice of antibiotic and combination ratio should be based on the specific infection, patient factors, and local resistance patterns 4.