What is the recommended treatment for a patient with a cat bite and no spontaneous bleeding, considering potential risks of infection and tetanus?

Cat Bite Management Without Spontaneous Bleeding

All cat bites should be evaluated in a medical facility as soon as possible due to high infection risk, and most patients should receive prophylactic antibiotics, particularly for hand wounds, puncture wounds, or wounds near joints. 1, 2

Immediate Wound Care

Thorough irrigation is the single most critical intervention to reduce bacterial load and prevent infection:

• Irrigate copiously with running tap water or sterile normal saline until no visible debris remains 1, 2
• Use a 20-mL or larger syringe to generate adequate irrigation pressure 2, 3
• Remove only superficial debris—avoid aggressive debridement that could enlarge the wound and impair closure 1
• Do not use povidone-iodine or antibiotic-containing solutions for routine cleansing 1, 2

Critical pitfall: Simple rinsing without adequate pressure may fail to remove bacterial contamination. 1

Antibiotic Prophylaxis

Amoxicillin-clavulanate 875/125 mg twice daily is the first-line antibiotic for cat bites, providing essential coverage against Pasteurella multocida (present in 75% of cat bite wounds). 1, 2

When to Give Prophylactic Antibiotics:

• All hand wounds (highest infection risk) 1, 2
• All puncture wounds (characteristic of cat bites) 3
• Wounds near joints or bones 2
• Deep wounds 1
• Immunocompromised patients 2
• Wounds presenting within 24 hours 1

Do not give antibiotics if the patient presents ≥24 hours after the bite with no signs of infection. 1

Duration:

• 3-5 days for prophylaxis 1, 2
• 7-10 days for established infection 2

Alternative Regimens:

• Penicillin-allergic patients: Doxycycline 100 mg twice daily 1, 2
• Other options requiring anaerobic coverage: Fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin) plus metronidazole or clindamycin 1

Avoid these antibiotics (poor activity against P. multocida): first-generation cephalosporins (cephalexin), penicillinase-resistant penicillins (dicloxacillin), macrolides (erythromycin), and clindamycin monotherapy. 1, 2

Wound Closure Decisions

Do not close cat bite wounds except for facial lacerations. 1, 2

• Facial wounds: Can be closed primarily after meticulous irrigation and debridement, with concurrent prophylactic antibiotics 1, 2
• Non-facial wounds: Use Steri-Strips for approximation if needed, followed by delayed primary or secondary closure 1
• Never close infected wounds (purulent discharge, erythema, established infection) 1, 2

Suturing within 8 hours is controversial with no definitive guidelines—err on the side of leaving wounds open except for cosmetically sensitive areas. 1

Tetanus Prophylaxis

Administer tetanus toxoid 0.5 mL intramuscularly if vaccination status is outdated or unknown. 1, 2

• Dirty wounds (all cat bites): Booster needed if >5 years since last dose 2
• Clean wounds: Booster needed if >10 years since last dose 2

Critical pitfall: Failure to administer tetanus prophylaxis for high-risk wounds can result in severe, preventable disease. 4

Rabies Prophylaxis

Rabies prophylaxis is generally not required for domestic cat bites in the United States, but consult local health departments for regional risk assessment. 1, 2

• Consider prophylaxis for: Feral or stray cat bites in high-prevalence areas 1, 2
• If indicated: Administer both rabies immunoglobulin (20 IU/kg infiltrated around wound) and vaccine (days 0,3,7,14) to previously unvaccinated individuals 1

Elevation and Follow-Up

• Elevate the injured extremity (especially if swollen) during the first few days to accelerate healing 1, 2
• Follow-up within 24 hours by phone or office visit for all outpatients 1, 2
• Monitor for infection signs: Increasing pain, redness, swelling, foul-smelling drainage, fever 1, 2
• Hospitalize if: Infection progresses despite appropriate antibiotics, deep tissue involvement suspected, or patient is immunocompromised 1, 2

High-Risk Complications

Cat bites carry higher infection risk than dog bites (30-50% vs. 5-25%) and more frequently cause serious complications including: 1

• Septic arthritis (requires 3-4 weeks of antibiotics) 1
• Osteomyelitis (requires 4-6 weeks of antibiotics) 1
• Tenosynovitis 1
• Bacteremia (especially Capnocytophaga canimorsus in asplenic or cirrhotic patients) 1

Pain disproportionate to injury near a bone or joint suggests periosteal penetration—requires immediate evaluation for deep infection. 1