How should a cat bite be managed, including wound care, tetanus prophylaxis, antibiotics, and rabies considerations?

Treatment for Cat Bite

Cat bites require immediate copious irrigation with soap and water for 15 minutes, prophylactic amoxicillin-clavulanate for 3–5 days (especially for hand wounds), tetanus prophylaxis if indicated, and rabies risk assessment—with most cat bites left open rather than sutured due to high infection risk.

Immediate Wound Care

• Wash the wound immediately and thoroughly with soap and water for approximately 15 minutes to reduce bacterial load and potential rabies transmission 1, 2
• After soap-and-water cleansing, irrigate with povidone-iodine solution using a ≥20 mL syringe to further reduce viral and bacterial contamination 1, 2
• Use sterile normal saline as an alternative irrigant when available 2
• Avoid high-pressure irrigation because it can drive bacteria deeper into tissues 2
• Remove all superficial foreign bodies and debris before any debridement 2
• Debride only tissue that is clearly non-viable, avoiding unnecessary wound enlargement 2
• Examine wounds carefully for tendon or bone involvement, joint penetration, or disproportionate pain near bones or joints 1, 3

Wound Closure Decision

• Do not close most cat bite wounds primarily—cat bites have a 30–50% infection rate compared to 5–25% for dog bites 2
• Deep puncture wounds (especially cat bites) should remain open due to high infection risk 2
• Hand wounds carry extremely high infection risk and should never be closed primarily 2
• Facial wounds may be considered for primary closure after meticulous cleaning and prophylactic antibiotics, preferably by a specialist 2
• Wounds older than 8 hours should not be closed primarily 2
• If closure is performed, use Steri-Strips and consider delayed primary or secondary closure techniques 2

Clinical Pearl: Cat bite wounds on the hand have the greatest risk of infection and can rapidly progress to serious complications including tenosynovitis, septic arthritis, and osteomyelitis 4, 5

Antibiotic Prophylaxis

• First-line regimen: amoxicillin-clavulanate administered twice daily for 3–5 days 1, 2, 4
• This regimen covers the critical pathogens: Pasteurella multocida (isolated in over 50% of cat bite wounds), Staphylococcus aureus, Streptococcus species, and anaerobes 2, 4, 6
• Prophylactic antibiotics are particularly important for:
  • Hand wounds (highest priority) 2, 4, 5
  • Feet, areas near joints, face, or genital region 2
  • Deep or puncture wounds 2
  • Immunocompromised patients 1, 2
• For penicillin-allergic patients: doxycycline 100 mg twice daily provides excellent coverage of Pasteurella 1, 2, 3
• Alternative regimens include fluoroquinolone plus an agent active against anaerobes, or clindamycin plus a fluoroquinolone 1, 3
• Avoid first-generation cephalosporins, macrolides, or clindamycin alone because of poor activity against Pasteurella 2

Critical Warning: Pasteurella multocida can cause serious infection with severe complications, and Capnocytophaga canimorsus can cause fatal sepsis, especially in asplenic or immunocompromised patients 3, 4, 6

Tetanus Prophylaxis

• Assess tetanus immunization status and administer tetanus toxoid if the last dose was >5 years ago for contaminated wounds 1, 2
• If vaccination status is unknown, give 0.5 mL intramuscular dose of tetanus toxoid 2
• Prefer Tdap over Td for individuals who have not previously received Tdap 2

Rabies Prophylaxis Assessment

• Consult local public health department to determine need for rabies prophylaxis 2
• Indications for rabies prophylaxis include:
  • Bites from wild, feral, or stray cats 2
  • Cats with unknown vaccination status or unavailable for observation 2
  • Exposure in geographic regions with high rabies prevalence 2
• If indicated, rabies prophylaxis schedule:
  • Day 0: Human rabies immune globulin (HRIG) 20 IU/kg infiltrated around the wound plus first vaccine dose at separate anatomical site 1, 2
  • Days 3,7,14: Additional vaccine doses 2
  • HRIG may be given up to day 7 after first vaccine dose if not administered initially; after day 7, HRIG is not indicated 1
• For healthy domestic cats: confine and observe for 10 days; if the cat remains healthy, no rabies prophylaxis is needed 1

Follow-up and Monitoring

• Arrange follow-up within 24 hours, either by telephone or in-person visit 2
• Elevate the injured limb using a passive method (e.g., sling) to reduce swelling 2
• Monitor for signs of infection: increasing pain, erythema, edema, or purulent discharge 2
• Hand bites should be examined by a specialist to rule out synovial, capsular, or bony involvement 2
• If infection progresses despite appropriate therapy, consider hospital admission 2

Complication Alert: Cat bites can cause rapidly progressive infections within 24 hours, particularly on the hand, requiring prompt surgical drainage and debridement 7, 5

Extended Therapy for Complications

• Septic arthritis: treat for 3–4 weeks 2
• Osteomyelitis: treat for 4–6 weeks 2
• Intensive hand physiotherapy after a short period of immobilization is critical for optimal functional recovery 5

Common Pitfalls to Avoid

• Never delay wound cleansing—it is the first and most important intervention 1
• Do not close infected wounds or hand wounds primarily; doing so increases risk of serious complications 2
• Topical antibiotics alone are insufficient for bite wounds; systemic therapy is required 2
• Underestimating hand bites can lead to tenosynovitis, septic arthritis, or osteomyelitis 2, 5
• Inadequate irrigation markedly increases infection and rabies transmission risk 2