Can Augmentin (amoxicillin‑clavulanate) treat cat‑scratch disease?

Augmentin for Cat Scratch Disease

No, Augmentin (amoxicillin-clavulanate) should not be used to treat cat scratch disease itself—azithromycin is the first-line treatment for cat scratch disease caused by Bartonella henselae. 1, 2

However, there is an important distinction between treating cat scratch disease (the infection caused by Bartonella henselae) versus treating infected cat scratches (wound infections from the scratch itself). Augmentin is appropriate for the latter but not the former.

When Augmentin IS Appropriate: Infected Cat Scratches

Amoxicillin-clavulanate is the first-line antibiotic for preventing and treating wound infections from cat scratches, particularly for deep wounds, wounds on hands/feet/face, or in immunocompromised patients. 1

• Augmentin provides excellent coverage against Pasteurella multocida and other common bacterial pathogens that cause wound infections from cat scratches. 1
• Prophylactic antibiotics with amoxicillin-clavulanate are recommended for high-risk wounds to prevent the 10-20% infection rate associated with cat scratches. 1
• Dosing: 875/125 mg twice daily for adults. 1

When Augmentin Is NOT Appropriate: Cat Scratch Disease

Cat scratch disease is a distinct clinical entity caused by Bartonella henselae and requires different treatment. 2

Clinical Features of Cat Scratch Disease:

• Papule or pustule develops 3-30 days after cat exposure. 2, 3
• Regional lymphadenopathy appears approximately 3 weeks after inoculation. 2, 3
• Lymph nodes typically resolve within 1-6 months, with suppuration in ~10% of cases. 2, 3
• Extranodal disease occurs in ≤2% of cases (hepatosplenic involvement, neuroretinitis, encephalopathy). 2, 3

First-Line Treatment for Cat Scratch Disease:

Azithromycin is the recommended first-line antibiotic for cat scratch disease, based on placebo-controlled evidence showing more rapid reduction in lymph node size. 1, 2, 4

Dosing:

• Adults and patients >45 kg: 500 mg on day 1, then 250 mg daily for 4 additional days. 1, 2, 3
• Children <45 kg: 10 mg/kg on day 1, then 5 mg/kg daily for 4 additional days. 1, 2, 3

Alternative Treatments for Cat Scratch Disease:

If azithromycin is contraindicated:

• Doxycycline 100 mg twice daily for 10-14 days (adults). 1, 2
• Erythromycin 500 mg four times daily (preferred for pregnant/breastfeeding women, as doxycycline is absolutely contraindicated). 2

Critical Pitfalls to Avoid

Do not use penicillins or first-generation cephalosporins for cat scratch disease—they have no in vivo activity against Bartonella henselae. 2

Clindamycin should not be used as monotherapy for either infected cat scratches or cat scratch disease, as it lacks coverage for Pasteurella multocida and has poor activity against Bartonella. 1

For immunocompromised patients (especially HIV with CD4+ <100 cells/µL), more aggressive treatment is required:

• Erythromycin or doxycycline for >3 months for bacillary angiomatosis or disseminated disease. 2
• Doxycycline with or without rifampin for CNS involvement. 2

Special Populations

Pregnant women: Erythromycin is the only safe option; tetracyclines and fluoroquinolones are contraindicated. 2

Breastfeeding women: Erythromycin 500 mg four times daily is safe and compatible with lactation. 2

Severe neuroretinitis: Doxycycline 100 mg plus rifampin 300 mg twice daily for 4-6 weeks showed benefit in case series. 5

Treatment Decision Algorithm

1. Is this a wound infection from a cat scratch? → Use amoxicillin-clavulanate 875/125 mg twice daily. 1

2. Is this cat scratch disease (lymphadenopathy 3 weeks post-scratch)? → Use azithromycin 500 mg day 1, then 250 mg × 4 days. 1, 2

3. Is the patient immunocompromised or pregnant? → Adjust antibiotic choice accordingly (erythromycin for pregnancy, prolonged therapy for immunocompromised). 2

4. Is there extranodal or disseminated disease? → Consider doxycycline + rifampin and infectious disease consultation. 2, 5