What are the treatment recommendations for a patient with a cat bite, assuming tetanus vaccination will be updated and Augmentin (amoxicillin and clavulanic acid) will be prescribed, and considering potential complications and alternative treatments for patients with weakened immune systems or allergies to penicillin?

Cat Bite Management

Yes, your plan is appropriate, but you must also address rabies prophylaxis and ensure proper wound care with thorough irrigation—these are critical steps that should not be overlooked. 1

Immediate Wound Management

• Irrigate the wound immediately and copiously with sterile saline or dilute povidone-iodine solution using a 20-mL or larger syringe to remove debris and reduce bacterial load—this is the single most important intervention to prevent infection and rabies transmission 2, 1, 3
• Explore the wound carefully for tendon, bone, or joint involvement, as cat bites frequently cause deep puncture wounds that can lead to serious complications like septic arthritis or osteomyelitis 2, 1
• Pain disproportionate to the injury near a bone or joint suggests periosteal penetration and warrants more aggressive evaluation and possibly imaging 2, 1
• Avoid primary closure of most cat bite wounds, especially puncture wounds and hand wounds, as this increases infection risk 2, 3

Antibiotic Therapy

• Amoxicillin-clavulanate (Augmentin) 875/125 mg twice daily is the correct first-line choice for cat bites, providing essential coverage against Pasteurella multocida (present in 75% of cat bites), staphylococci, streptococci, and anaerobes 2, 1, 4
• Cat bites have a 20-80% infection rate (much higher than dog bites at 3-18%), making antibiotic prophylaxis particularly important 5, 4
• For penicillin-allergic patients, use doxycycline 100 mg twice daily OR a fluoroquinolone (ciprofloxacin or levofloxacin) plus metronidazole 2, 1
• Avoid first-generation cephalosporins, macrolides, and clindamycin alone as they have poor activity against P. multocida 2

Tetanus Prophylaxis

• Administer tetanus toxoid (Td) 0.5 mL IM if more than 5 years have elapsed since the last dose for this contaminated wound 2, 1
• For clean, minor wounds, tetanus booster is only needed if more than 10 years have passed 2
• If the patient has an incomplete primary vaccination series or unknown vaccination history, also give tetanus immune globulin (TIG) 250 units IM at a separate site 2

Rabies Prophylaxis - Critical Step

• For a domestic cat that can be confined and observed: hold rabies prophylaxis and observe the cat for 10 days; if the cat remains healthy, no rabies treatment is needed 2, 1
• For stray, unavailable, or sick-appearing cats: initiate rabies post-exposure prophylaxis immediately with rabies immune globulin (RIG) and rabies vaccine series on days 0,3,7, and 14 2, 1, 3
• Contact your local animal control/health department to report the bite and arrange for animal observation or testing 2

Follow-up and Monitoring

• Re-evaluate within 48-72 hours to assess for signs of infection: increasing pain, redness, swelling, warmth, or purulent discharge 1, 3
• Hand wounds and immunocompromised patients require particularly close monitoring due to higher complication rates 2, 1
• Elevate the injured extremity to reduce swelling and accelerate healing 2
• Consider hospitalization for IV antibiotics if infection progresses despite oral therapy, or if there is evidence of deep space infection, septic arthritis, or osteomyelitis 2, 1

Common Pitfalls to Avoid

• Do not skip wound irrigation—this is more important than antibiotics alone for preventing infection 2, 3
• Do not forget rabies assessment—even domestic cats may be unvaccinated, and rabies is universally fatal once symptomatic 2
• Do not use inadequate antibiotics—monotherapy with cephalexin, dicloxacillin, or clindamycin will miss P. multocida coverage 2
• Do not underestimate cat bites—they appear minor but have the highest infection rate of all animal bites, particularly on the hand 2, 5, 4