What is the management approach for a patient with a cat bite, considering potential complications such as infection, tetanus, and rabies?

Cat Bite Management

Immediate Wound Care

All cat bite wounds require immediate and thorough irrigation with sterile normal saline or water as the single most important intervention to reduce bacterial load and prevent infection. 1, 2

• Use a 20-mL or larger syringe to generate adequate pressure for effective wound cleansing 3
• Remove only superficial debris—avoid aggressive debridement that could enlarge the wound unnecessarily 1
• Do not use iodine- or antibiotic-containing solutions for routine cleansing 1

Antibiotic Therapy

Amoxicillin-clavulanate (875/125 mg twice daily) is the first-line antibiotic for cat bites, providing essential coverage against Pasteurella multocida, which is isolated in over 50% of cat bite wounds. 3, 4

• Hand wounds and wounds near joints or bones require prophylactic antibiotics due to high infection risk 1, 5
• Cat bites carry significantly higher infection risk than dog bites, particularly puncture wounds on the hand 4
• Treatment duration: 3-5 days for prophylaxis, 7-10 days for established infection 1
• For penicillin-allergic patients, use doxycycline 100 mg twice daily 3
• Avoid first-generation cephalosporins, macrolides, or clindamycin alone—these have poor activity against Pasteurella multocida 3

Severe Infections Requiring IV Therapy

• Use ampicillin-sulbactam, piperacillin-tazobactam, second-generation cephalosporins, or carbapenems for severe infections 1
• Extended therapy: 3-4 weeks for septic arthritis, 4-6 weeks for osteomyelitis 1

Wound Closure Decisions

Do not close cat bite wounds except for facial lacerations. 3, 6

• Facial wounds are the explicit exception: after meticulous irrigation and debridement, facial cat bites may be closed primarily with concurrent prophylactic antibiotics due to the rich vascular supply 3
• For non-facial clean wounds seen early, use Steri-Strips rather than sutures if approximation is needed 1
• Never close infected wounds—this includes any wound with purulent discharge, erythema, or signs of established infection 3

Tetanus Prophylaxis

Tetanus prophylaxis is mandatory for all cat bites. 1, 3

• Administer tetanus toxoid 0.5 mL intramuscularly if vaccination status is outdated or unknown 1
• For dirty wounds (all cat bites qualify): booster needed if >5 years since last dose 1
• For clean wounds: booster needed if >10 years since last dose 1

Rabies Prophylaxis

Rabies prophylaxis is generally not required for domestic cat bites in the United States, but consultation with local health departments is necessary for regional risk assessment. 1, 3

• Small mammals including domestic cats are rarely infected with rabies 1
• Consider prophylaxis only for feral or stray cat bites in high-prevalence areas 1
• If indicated, administer both rabies immunoglobulin and vaccine for previously unvaccinated individuals 3

Special Populations and High-Risk Scenarios

HIV-infected patients face increased risk of Bartonella infection (cat scratch disease) from cat bites and scratches. 7

• Wash cat bite and scratch sites promptly in immunocompromised patients 7
• Do not allow cats to lick open wounds in HIV-infected individuals 7
• Flea control reduces Bartonella transmission risk 7

Follow-Up and Monitoring

• Elevate the injured extremity to reduce swelling 1
• Follow up within 24 hours by phone or office visit for all outpatients 1, 3
• Monitor for signs of infection: increasing pain, redness, swelling, purulent discharge 3
• Hospitalize if infection progresses despite appropriate antibiotics, deep tissue involvement is suspected, or patient is immunocompromised 1

Critical Pitfalls to Avoid

• Never underestimate cat bite puncture wounds—they appear deceptively minor but have the highest infection rate of all mammalian bites, especially on the hand 4
• Do not delay antibiotic initiation for hand wounds or wounds near joints 1, 5
• Do not close non-facial cat bite wounds—the infection risk is too high 3, 6
• Do not use topical antibiotics alone—they cannot address the polymicrobial flora in bite wounds 3
• Pasteurella multocida can cause rapid-onset cellulitis within 24 hours and may lead to septic shock, meningitis, or endocarditis if untreated 8