What is the most appropriate next step in management for a patient bitten by a febrile and lethargic cat with no signs of infection at the bite site?

Management of Cat Bite with Febrile and Lethargic Cat

Given the cat's abnormal behavior (febrile and lethargic) with unknown vaccination history, the most appropriate next step is to give rabies immunoglobulin and vaccine (Option D), followed immediately by wound irrigation and prophylactic antibiotics.

Rabies Post-Exposure Prophylaxis Takes Priority

• The World Health Organization recommends initiating rabies post-exposure prophylaxis immediately if the cat is newly adopted with unknown vaccination history and showing abnormal behavior 1
• A febrile and lethargic cat represents a high-risk scenario for rabies transmission, as these are classic signs of rabid animal behavior 1
• Rabies is universally fatal once symptoms develop, making this the most critical intervention for mortality prevention 1
• The absence of redness at the bite site does not rule out serious infection risk or rabies exposure 1

Wound Irrigation Must Follow Immediately

• Thoroughly irrigate the wound with copious sterile normal saline to remove debris and reduce bacterial load, which is critical for preventing infection 1
• Deep irrigation serves to remove foreign bodies and pathogens, though irrigation under pressure is not recommended as it may spread bacteria into deeper tissue layers 2

Prophylactic Antibiotics Are Essential for Cat Bites

• Cat bites have an infection rate of 30-50%, significantly higher than dog bites (5-25%), making prophylactic antibiotics strongly indicated 2, 1
• The Infectious Diseases Society of America recommends amoxicillin-clavulanate 875/125 mg twice daily as first-line therapy, providing optimal coverage against Pasteurella multocida (present in 75% of cat bites), anaerobes, staphylococci, and streptococci 1, 3
• Approximately 90% of domestic cats carry P. multocida in their oral cavity, with high antibiotic susceptibility to amoxicillin-clavulanate (100%) 4
• For penicillin-allergic patients, doxycycline 100 mg twice daily is recommended as an excellent alternative 1, 3

High-Risk Features in This Case

• Cat bites create deep puncture wounds in 92% of cases, which penetrate through the skin and carry higher infection risk 5
• Prophylactic antibiotics should be given for 3-5 days for fresh, deep wounds, regardless of the absence of initial signs of infection 2
• Antibiotics should not be withheld based on the absence of redness, as P. multocida infections characteristically develop rapidly within 12-24 hours after the bite 5, 6

Additional Essential Management

• Assess tetanus immunization status and administer tetanus toxoid if not received within the past 10 years 1
• Elevate the injured body part if swollen to accelerate healing 1
• The cat should be quarantined for 10-day observation if possible, but rabies prophylaxis should not be delayed while awaiting observation results given the abnormal behavior 1

Critical Pitfall to Avoid

• Never reassure and discharge without intervention—cat bites appear trivial but have the highest infection rates among animal bites, and this scenario presents dual threats of both rabies and bacterial infection 1
• The combination of unknown vaccination history and abnormal cat behavior (febrile, lethargic) makes rabies prophylaxis non-negotiable 1