What is the treatment for cat scratch disease (CSD)?

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From the Guidelines

To treat a cat scratch, azithromycin is recommended for patients with cat scratch disease, with a dosing protocol of 500 mg on day 1 followed by 250 mg for 4 additional days for patients weighing ≥45.5 kg, and 10 mg/kg on day 1 and 5 mg/kg for 4 more days for patients weighing <45.5 kg, as supported by the Infectious Diseases Society of America guidelines 1.

Initial Wound Care

When treating a cat scratch, it is essential to start by cleaning the wound thoroughly with mild soap and warm water for at least 20 seconds, then rinsing completely. Applying an antiseptic like hydrogen peroxide or povidone-iodine (Betadine) can help prevent infection. The scratch should be covered with a clean bandage, which should be changed daily or when it becomes wet or dirty.

Antibiotic Ointment and Pain Management

Applying an antibiotic ointment like Neosporin or Polysporin to the wound before bandaging can further prevent infection. For pain management, acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) can be taken as directed if needed.

Monitoring for Infection

It is crucial to monitor the wound for signs of infection, such as increasing redness, swelling, warmth, pus, or red streaks extending from the wound. If these signs develop, or if there is a deep puncture wound, or if the patient is immunocompromised, medical attention should be sought promptly.

Cat Scratch Disease Prevention

Cat scratches can sometimes lead to cat scratch disease, caused by the bacteria Bartonella henselae, which cats carry without showing symptoms. Proper cleaning of the wound is essential as it removes bacteria before they can cause infection. Most cat scratches heal within 7-10 days with proper home care, but azithromycin treatment, as recommended by the guidelines 1, can help manage cat scratch disease effectively.

Key Considerations

  • Clean the wound thoroughly with mild soap and warm water.
  • Apply an antiseptic and cover the wound with a clean bandage.
  • Use antibiotic ointment and manage pain as needed.
  • Monitor for signs of infection and seek medical attention if necessary.
  • Azithromycin is the recommended treatment for cat scratch disease, following the specified dosing protocol 1.

From the Research

Cat Scratch Treatment

There are no research papers to assist in answering this question, as the provided studies focus on the treatment of acute sinusitis, community-acquired pneumonia, and the properties of amoxicillin and amoxicillin-clavulanic acid, but do not mention cat scratch treatment.

  • The studies 2, 3, 4 compare the efficacy of azithromycin and amoxicillin/clavulanate in treating various infections, but do not provide information on cat scratch treatment.
  • Study 5 discusses the safety review of amoxicillin and amoxicillin plus clavulanate, while study 6 examines the properties, indications, and usage of oral amoxicillin and amoxicillin-clavulanic acid, but neither addresses cat scratch treatment.
  • Therefore, there is no relevant information available to provide a response to the question about cat scratch treatment.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Amoxicillin and amoxicillin plus clavulanate: a safety review.

Expert opinion on drug safety, 2009

Research

Oral amoxicillin and amoxicillin-clavulanic acid: properties, indications and usage.

Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 2020

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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