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good topic
121. While visiting a neighbor, a 14-year-old girl is
bitten on the left hand by the neighbor’s pet cat.
The cat is an indoor pet and has had all of the
required routine vaccinations. You see the girl
in the office approximately 1 hour after the
injury. On the dorsum of the left hand you see
two shallow puncture wounds that are not
actively bleeding. She has full range of motion
of her hand, normal capillary refill, and sensation.
You see in the chart that the patient had a
diphtheria/tetanus (dT) booster vaccine last
year.
What is the most appropriate management
at this time?
(A) Recommend local care at home with
hydrogen peroxide and topical
antibiotics.
(B) Give a booster dT and start oral
cephalexin.
© Give an intramuscular (IM) dose of
penicillin and emergently refer to a
hand surgeon for debridement.
(D) Irrigate the wounds and prescribe oral
amoxicillin/clavulanic acid (Augmentin).
(E) Start oral ciprofloxacin and refer to
the health department for rabies
prophylaxis
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(D) Irrigate the wounds and prescribe oral
amoxicillin/clavulanic acid (Augmentin).
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(D) Animal bites, most commonly from pet
dogs and cats, result in over 1 million wounds
in the United States each year. Bites and
scratches from cats are prone to infection with
organisms that are normally found in the
animal’s oropharynx. These infections tend to
be polymicrobic and include alpha-hemolytic
streptococci, staphylococci, and Pasteurella
species, among others. Pasteurella infections
tend to spread rapidly, often within hours. Cat
bites may also result in the transmission of
rabies and tetanus. In the setting of a well cared
for indoor house pet, rabies would be unlikely
and rabies vaccine unnecessary, although
reporting the injury to the health department
may be required (depending on local statute).
A dT booster would not be necessary, as she
had one within a year. Surgical debridement
would not be necessary for a shallow wound
with normal hand function. If there were signs
of tendon, nerve, or vascular injury, then surgical
evaluation would be mandatory. Local
care alone would not be appropriate because of
the propensity for cat bite wounds to become
infected. Antibiotic prophylaxis is recommended
for most cat bite wounds, particularly
those involving the hands. The recommended
first-line agent is a combination of beta-lactam
and beta-lactamase inhibitor, such as amoxicillin/
clavulanic acid. An alternative regimen includes
clindamycin with either TMP-SMZ (Bactrim
DS) or a fluoroquinolone.
