What is the treatment for a cat bite?

Cat Bite Treatment

Cat bites require immediate thorough wound cleansing, antibiotic prophylaxis with amoxicillin-clavulanate, tetanus prophylaxis as indicated, and rabies risk assessment—with cat bites having double the infection risk of dog bites and requiring particularly aggressive management. 1, 2

Immediate Wound Management

• Immediately wash and flush all cat bite wounds thoroughly with soap and water for approximately 15 minutes to reduce infection risk and potential rabies transmission 1
• After soap and water cleansing, irrigate with povidone-iodine solution as this virucidal agent further reduces rabies risk 1
• Examine the wound carefully for depth, tendon involvement, bone involvement, or joint penetration—pain disproportionate to injury near a bone or joint may indicate deeper penetration 1
• Debride necrotic tissue as needed, as irrigation and debridement are the most important factors in preventing infection 3
• Do NOT use high-pressure irrigation as it may spread bacteria into deeper tissue layers 3

Key Clinical Context

Cat bites carry a 30-50% infection rate, significantly higher than dog bites (5-25%), making them particularly dangerous 3. Hand wounds from cat bites have the greatest risk of infection 2. Cat bite wounds are typically deep puncture wounds that can seed bacteria into joints, tendons, and bone 4.

Antibiotic Prophylaxis

Amoxicillin-clavulanate is the first-line prophylactic antibiotic for cat bite wounds and should be given as early as possible 5, 6

• For penicillin-allergic patients, use doxycycline, or a fluoroquinolone plus an agent active against anaerobes, or clindamycin plus a fluoroquinolone 5
• Avoid first-generation cephalosporins, penicillinase-resistant penicillins, macrolides, and clindamycin alone as they have poor activity against Pasteurella multocida, which is isolated in over 50% of cat bite wounds 6, 2
• Antibiotic prophylaxis is particularly important for hand wounds, wounds over tendons or bones, deep wounds, facial wounds, and immunocompromised patients 3, 5
• Typical duration is 3-5 days for prophylaxis 3

Microbiology

The predominant pathogens include Pasteurella multocida (present in >50% of cat bites), Staphylococcus species (including MRSA), Streptococcus species, and anaerobes including Fusobacterium, Prevotella, Bacteroides, and Porphyromonas species 3, 1, 2

Tetanus Prophylaxis

• Assess tetanus immunization status and administer tetanus prophylaxis as indicated 1
• Administer tetanus toxoid to patients with unknown or incomplete tetanus immunization 1

Rabies Post-Exposure Prophylaxis Decision Algorithm

If the cat is healthy, available for 10-day observation, and properly vaccinated:

• Confine and observe the cat for 10 days without initiating prophylaxis 1

Initiate immediate rabies post-exposure prophylaxis if:

• The cat is stray or unwanted 1
• The cat cannot be confined for observation 1
• The cat dies or develops illness before completing the 10-day observation period 1
• The cat shows signs suggestive of rabies during observation 1
• The attack was unprovoked (unprovoked attacks are more likely to indicate rabies) 1

Rabies prophylaxis regimen consists of:

• Rabies Immune Globulin (administered on day 0) 1
• A 4-5 dose vaccine series for previously unvaccinated persons 1
• Do not exceed the recommended Rabies Immune Globulin dose, as excess can suppress active antibody production 1

Important Context

More cats than dogs are reported rabid in the United States, with the majority associated with raccoon rabies epizootics in the eastern US 1. Consult your local department of health about regional rabies risks 3.

Wound Closure Considerations

• Primary closure is generally not recommended for cat bite wounds due to high infection risk 3
• Facial wounds may be considered for closure if seen early and properly cleaned, weighing cosmetic factors against infection risk 5
• Deep wounds, puncture wounds, and hand wounds should typically be left open 4

Potential Complications to Monitor

• Infectious complications include septic arthritis, osteomyelitis, subcutaneous abscess formation, tendonitis, and bacteremia 1
• Pasteurella multocida can cause serious infection with severe complications, progressing rapidly within 24 hours 2, 7
• Sepsis and renal failure can occur, particularly in elderly or immunocompromised patients 7
• Hand wounds often have more serious complications than wounds to fleshy parts of the body 6

Risk Factors for Infection

Infections are more likely in patients with:

• Older age 4
• Longer time intervals until treatment 4
• Deeper wounds and puncture wounds 4
• Lower extremity wounds 4
• Immunocompromised status 8
• Wounds with evidence of edema or crushing 8