Can ceftriaxone (Rocephin) be used for prophylaxis after a cat scratch?

Ceftriaxone (Rocephin) is NOT recommended for cat scratch prophylaxis

No evidence supports the use of ceftriaxone for prophylaxis after a cat scratch, and guidelines explicitly state that penicillins and first-generation cephalosporins have no in vivo activity against Bartonella and should not be used. 1

Why Ceftriaxone is Inappropriate

• Ceftriaxone lacks activity against Bartonella henselae, the causative organism of cat scratch disease 1
• Penicillins and first-generation cephalosporins (and by extension, third-generation cephalosporins like ceftriaxone for this indication) have no demonstrated efficacy against Bartonella infections 1
• The guidelines you may have seen mentioning ceftriaxone were specifically for Salmonella gastroenteritis in HIV-infected patients, not for cat scratch disease or prophylaxis 2

What You Should Do Instead

Immediate Wound Management (Most Important)

• Promptly wash any cat-associated wound with soap and water immediately - this is the single most important intervention to prevent infection 1, 3
• Thorough cleansing with sterile normal saline removes superficial debris 3

When Prophylactic Antibiotics ARE Indicated

Consider prophylaxis for:

• Deep wounds 3
• Wounds on hands, feet, face, or near joints 3
• Immunocompromised patients 3

Correct Antibiotic Choice for Prophylaxis

• Amoxicillin-clavulanate is first-line for prophylaxis of infected cat scratches, providing coverage against Pasteurella multocida and other common pathogens 3
• For penicillin allergy: doxycycline 100 mg twice daily (adults) with excellent Pasteurella activity 3
• Alternative options include fluoroquinolones (ciprofloxacin 500-750 mg twice daily) or TMP-SMX plus metronidazole 3

If Cat Scratch Disease Develops (Treatment, Not Prophylaxis)

First-Line Treatment

• Azithromycin is the recommended first-line treatment: 500 mg on day 1, then 250 mg daily for 4 additional days (for patients >45 kg) 1
• For patients <45 kg: 10 mg/kg on day 1, then 5 mg/kg daily for 4 more days 1

Alternative Treatments

• Doxycycline 100 mg twice daily for 10-14 days if azithromycin is contraindicated 1, 3
• Erythromycin 500 mg four times daily as another alternative 1

Important Clinical Caveats

• Most cat scratch disease is self-limited and does not require antibiotic treatment in immunocompetent patients 4, 5, 6
• No data support chemoprophylaxis specifically for Bartonella/cat scratch disease - treatment is only indicated once disease develops 2
• Cat scratches have approximately 10-20% risk of infection (compared to 30-50% for actual bites) 3
• Regional lymphadenopathy typically appears 3 weeks after inoculation and resolves within 1-6 months 1

Special Populations

• Immunocompromised patients (especially HIV with CD4+ <100 cells/µL) require more aggressive evaluation and treatment due to risk of disseminated disease, bacillary angiomatosis, and peliosis hepatis 1, 3
• Pregnant women: Use erythromycin only; avoid doxycycline and fluoroquinolones completely 1, 3
• Children: Same treatment recommendations with weight-based dosing 1