Cat bites are a distant second when it comes to animal bites. The most frequent animal bites are dog bites. They can be physically and emotionally challenging injuries especially if the victims are children.
Cat bite management is complex and varies based on the severity of injury. The injuries can range from simple scratches to deeper and more complex wounds. Initial work up should include a high level of suspicion for deeper injuries to important nerves, tendons, blood vessels and bones of the hand. Bone fractures can be rare with cat bites because their teeth and jaw strength are not so conducive to such injuries. Fractures should be ruled out with hand X-Rays. MRI and CT scan should be done if infection or compartment syndromes are suspected in the deeper tissues and fascial layers of the hand, wrist and forearm.
Simple cat scratches or cat bite puncture wounds should be irrigated well in the emergency room and washed out and allowed to heal by secondary intention. Wound management and pressure irrigation is the mainstay of operative management of cat bites and animal bites. Secondary intention means that the wound is allowed to heal by itself with proper and guided wound care management.
Deeper cat bite wounds that are simple may also be managed in the emergency room. They require copious irrigation and wash out, debridement of any foreign debris and desiccated tissue and then surgical closure. Hand and limb elevation can help reduce swelling.
More complex cat bite wounds, or cat bite wounds on the face and neck, or cat bites in children will need to be treated in the operating room under general anesthesia.
In the operating cat bites must be irrigated well with copious solution of normal saline and antibiotics, undergo wound debridement and removal of all foreign debris. A layered closure should be next done.
Cat bite management must address the whole patient systemically. If the patient has not had a tetanus immunization within the last 5 years, then tetanus immunization (diphtheria/tetanus toxin) and tetanus immune globulin are recommended at the time of the cat bite.
If the immunization history of the cat is not known then rabies prophylaxis is also indicated. Rabies immune globulin (RIG) is recommended to be administered to the patient.
I am a proponent of early use of antibiotics on cat bites. The most common bacterial organism responsible for infection in cat bites is Pasteurella Multocida. It is not susceptible to cephalexin and clindamycin. I recommend (Amoxil) Amoxicilin/clavulanate. In the emergency room or operating room the patient can receive (Unasyn) Ampicillin/sulbactam. If a patient has allergy to penicillin then I recommend Doxycyclin or erythromycin. Doxycyclin should not be given to women who may be pregnant. Additionally I recommend (Bactrim) Sulfamethoxazole/trimethoprim either alone or in combination. Second and third generation cephalosporins can be used also and/or metronidazole.