What is the recommended treatment for a patient with a cat bite and strep throat, and no known allergies?

Treatment Recommendations for Cat Bite and Strep Throat

Amoxicillin-clavulanate 875/125 mg twice daily is the definitive first-line treatment that addresses both conditions simultaneously, providing optimal coverage for Pasteurella multocida from the cat bite and Group A Streptococcus from the strep throat. 1, 2

Rationale for Combined Treatment

This single antibiotic regimen efficiently treats both infections because:

• Cat bite coverage: Amoxicillin-clavulanate is the preferred agent for cat bites, which carry a 30-50% infection risk and commonly harbor Pasteurella multocida, Streptococcus species, Staphylococcus aureus, and anaerobes from the cat's oral flora 3, 1, 4

• Strep throat coverage: The amoxicillin component provides excellent activity against Streptococcus pyogenes (Group A Strep), the causative organism of strep throat 2

• Dual benefit: Rather than prescribing separate antibiotics for each condition, this single agent covers the polymicrobial nature of cat bites while simultaneously treating the streptococcal pharyngitis 1, 5

Specific Dosing and Duration

For the cat bite component:

• Amoxicillin-clavulanate 875/125 mg orally twice daily for 3-5 days if prophylactic (fresh wound), or 7-10 days if signs of infection are present 3, 1

For the strep throat component:

• Continue treatment for a minimum of 10 days total to prevent acute rheumatic fever, as required for any Streptococcus pyogenes infection 2

Therefore, treat for 10 days minimum to satisfy both conditions. 2

Immediate Wound Management

Before initiating antibiotics, the cat bite requires:

• Thorough irrigation with sterile normal saline to remove debris and reduce bacterial load 1
• Avoid high-pressure irrigation, as this can drive bacteria deeper into tissues 3
• Minimal debridement unless significant devitalized tissue is present 1
• Elevation of the affected body part if swelling is present 1

Critical Monitoring Parameters

For the cat bite, watch for:

• Signs of developing infection: increasing pain, redness, swelling, purulent drainage, or fever 1
• Serious complications including septic arthritis, osteomyelitis, or tendonitis (especially with hand wounds) 1
• Systemic spread: Pasteurella multocida can cause septic shock, meningitis, and endocarditis in rare cases 4, 6

For strep throat:

• Clinical improvement within 48-72 hours of antibiotic initiation 2
• Complete the full 10-day course even if symptoms resolve earlier to prevent rheumatic fever 2

Additional Preventive Measures

• Tetanus prophylaxis: Verify immunization status and update if the last dose was >5 years ago for contaminated wounds or >10 years for clean wounds 1
• Rabies assessment: Consider rabies risk if the cat's vaccination status is unknown or if it was a feral/stray cat 1

Common Pitfalls to Avoid

Do not use monotherapy with:

• Clindamycin alone (lacks Pasteurella coverage) 1
• First-generation cephalosporins (poor Pasteurella activity) 1
• Trimethoprim-sulfamethoxazole alone (inadequate Pasteurella coverage) 1

Do not delay antibiotic initiation if the bite involves:

• Deep puncture wounds (characteristic of cat bites) 3, 5
• Hands, feet, face, or areas near joints 3, 1
• Any wound showing early signs of infection 3

Alternative Regimens (If Penicillin Allergy Develops)

If the patient later reports a penicillin allergy:

For cat bite:

• Doxycycline 100 mg twice daily (excellent Pasteurella activity) 1
• OR Ciprofloxacin 500-750 mg twice daily plus metronidazole for anaerobic coverage 1

For strep throat:

• Azithromycin 500 mg day 1, then 250 mg days 2-5 1
• OR Cephalexin if only mild penicillin allergy (not anaphylaxis)

Follow-Up Timing

• Return immediately if fever develops, wound shows increasing redness/swelling, or purulent drainage appears 1
• Routine follow-up at 48-72 hours to ensure both infections are responding to therapy 3, 1
• Extended monitoring may be needed for several weeks if deep tissue involvement is suspected 2