Augmentin Dosing for Cat Scratch
For a simple cat scratch wound, prescribe amoxicillin-clavulanate (Augmentin) 875/125 mg twice daily for 7-10 days to prevent infection, particularly for deep wounds, hand injuries, or immunocompromised patients. 1
When to Prescribe Prophylactic Antibiotics
Prophylactic antibiotics are indicated for:
- Deep wounds or puncture-type scratches 1
- Scratches on hands, feet, face, or near joints 1
- Immunocompromised patients 1
- Any scratch with significant tissue damage 1
Cat scratches carry approximately 10-20% infection risk, making prophylaxis reasonable for high-risk wounds. 1
Standard Dosing Regimen
Amoxicillin-clavulanate 875/125 mg orally twice daily is the first-line therapy, providing optimal coverage against Pasteurella multocida (the primary pathogen in cat scratches), staphylococci, streptococci, and anaerobes. 2, 1, 3
- Treatment duration: 7-10 days for uncomplicated wounds 1, 3
- This dosing provides excellent activity with 100% susceptibility against P. multocida 3
Alternative Regimens for Penicillin Allergy
If the patient cannot tolerate penicillins:
- Doxycycline 100 mg twice daily - excellent Pasteurella activity, though some streptococci may be resistant 2, 1, 3
- Ciprofloxacin 500-750 mg twice daily - good Pasteurella coverage but misses MRSA and some anaerobes 2, 1, 3
- TMP-SMX 160-800 mg twice daily PLUS metronidazole 250-500 mg four times daily - combination provides aerobic and anaerobic coverage 2, 1
Critical Distinction: Cat Scratch Disease vs. Cat Scratch Wound
This is NOT the same as cat scratch disease (CSD), which is caused by Bartonella henselae and presents with regional lymphadenopathy 3 weeks after inoculation. 2
For confirmed cat scratch disease with lymphadenopathy:
- Azithromycin 500 mg on day 1, then 250 mg daily for 4 additional days (for patients >45 kg) 1
- Azithromycin showed 51.4% resolution rates in pediatric studies 4
- Most CSD cases are self-limited and resolve without antibiotics in 1-6 months 2
Antibiotics to AVOID for Cat Scratches
- First-generation cephalosporins (cephalexin, cefazolin) - miss P. multocida and anaerobes 2, 3
- Clindamycin monotherapy - misses P. multocida despite good activity against staphylococci and anaerobes 2, 1
- Penicillin alone - inadequate coverage for polymicrobial flora 2
Additional Wound Management
Beyond antibiotics:
- Thoroughly cleanse with sterile normal saline to remove debris 1
- Evaluate tetanus immunization status and update if needed 1
- Assess rabies risk for scratches from unknown or feral cats 1
- Elevate the injured area if swollen to accelerate healing 1
When to Escalate Care
Instruct patients to return immediately if they develop:
- Increasing pain, redness, or swelling 1
- Purulent drainage 1
- Fever or systemic symptoms 1
- Hand wounds require particularly close monitoring for septic arthritis, osteomyelitis, or tendonitis 3
For severe infections requiring hospitalization, switch to ampicillin-sulbactam 1.5-3.0 g IV every 6-8 hours or piperacillin-tazobactam 3.37 g IV every 6-8 hours. 2, 3