Antibiotic (Antimicrobial) use in cat fight wounds and cat bite abscesses

Introduction

RUMA CA&E’s aim is to galvanise and support the veterinary profession to reduce antibiotic (antimicrobial/antibacterial) use in Cat fight wounds (CFW) and for cat bite abscessation (CBA). Current BSAVA/SAMSoc PROTECT ME guidance, alongside expert guidance and opinion of the RUMA CA&E working group that has focused on this  condition, is that antibiotic therapy is rarely required where signs of systemic illness are absent. Lancing and draining a cat bite abscess is the best approach and is likely to be the most effective treatment. This is backed up by clinical audits.

Expert opinion supporting this can be found here:

On this page

Why antibiotics are rarely indicated to treat CBA/CFW

Evidence, clinical opinion and clinical experience suggests that antibiotics are rarely necessary in CBA/CFW cases where signs of systemic illness are absent. This is because most localised abscesses are covered by a thick fibrous capsule which isolates the bacteria within the capsule, usually stops further spread to other parts of the body and prevents antibiotics from penetrating inside, meaning that antibiotics can’t treat the abscess effectively. This helpful animation created by The Royal Veterinary College (RVC) and VetCompass helps illustrate the opportunity that exists to reduce the use of antibiotics in the treatment of CFW/CBA. This is ideal to play at team meetings. In addition, for members of the practice team that want further details, the RCVS Knowledge VetTeamAMR training includes a 12 minute webinar by Sivert Nerhagan from the Norwegian University of Life Sciences, which talks through the causes, presenting signs and treatment of cat bite abscesses. Lancing and draining a cat bite abscess is the best approach and is likely to be the most effective treatment combined with appropriate pain relief. 

Why using antibiotics can be harmful?

Every time antibiotics are used, bacteria get a chance to develop resistance and this makes it harder to treat infections for that patient in the future. In addition, bacteria are shared between pets and their owners (and vice versa). Antimicrobial resistance (AMR) is projected to cause up to 39 million human deaths by 2050 if left unchecked and will make our jobs more difficult; there will be conditions we can no longer treat and surgeries we can no longer carry out.  In addition, antibiotics can have side effects such as gastrointestinal issues, including vomiting, diarrhoea, and loss of appetite. It is well established that, antibiotic use will disrupt the gut microbiota (dysbiosis), reducing microbial diversity and altering normal gut function; these changes may persist beyond the treatment period and can be associated with longer-term effects on gut health.  This doesn’t mean antibiotics should never be used – it just means they should only be used when necessary.

How to assess if a cat with a CBA or CFW requires antibiotics or not, plus guidance on lancing, draining and sedation

Most simple cat bite abscesses will heal successfully with adequate drainage and cleaning, without antibiotics. The pus is essentially a walled-off infection, and removing it resolves the problem. Lancing should therefore be the key recommendation to make to clients. 

Here are some key considerations for deciding if antibiotics are needed or not at first presentation:

  • Are there signs of SIRS – Systemic Inflammatory Response Syndrome – PubMed 
  • Is there evidence of cellulitis (infection spreading generally through tissues rather than forming a localised discrete pocket)?
  • Is the abscess in a critical location? (e.g. penetration into a joint or bone or very close association to the eye)
  • Is the cat significantly immunocompromised? 

Guidance on lancing drainage and sedation

    • Lancing and drainage: The main treatment goal if there are no complicating health factors, will be to drain the abscess in order to release the trapped pus and bacteria. This often requires a veterinary professional to lance (make an incision into) the abscess and thoroughly flush the cavity with saline. It will be important to provide aftercare guidance to owners on cleaning the wound at home. 
    • Sedation: In most cases, lancing can be achieved without sedation. In some cases, the site of the abscess and/or the behaviour of the cat means sedation may need to be considered. In rare cases, usually where the abscess is in a critical location and may require exploration, anaesthesia may be necessary. Each case needs to be approached in a contextualised patient centred way to establish the most effective approach.
    • Pain relief should be prescribed unless contraindicated.

 

If for some reason you are unable to lance the abscess (e.g. the cat may be unmanageable, and if the abscess is in a non-critical location, the recommendation remains not to prescribe antibiotics (pain relief is still important), as they won’t penetrate the abscess and will still be ineffective. Most abscesses will mature and rupture themselves.

Some useful guidance on interacting with cats in a practice environment to keep them calm can be found here: Interacting with cats in the clinic – International Cat Care.

The consequences of cat bites and scratches in people are different so you should always follow your practice protocols if any team member or the owner/carer is bitten or scratched.

When antibiotics are necessary and choice of treatment

Antibiotics will likely be prescribed in certain situations. If your clinical assessment is that the cat needs antibiotics e.g. if you detect signs of systemic inflammatory response, then it is important to trust your clinical judgement.

If you think your patient needs antibiotics, still lance and flush if necessary. It is better to take a sample for culture and sensitivity before starting treatment. You can then start empirical treatment before waiting for the culture results to come back. Good initial choices are cefalexin, amoxicillin or amoxicillin-clavulanic acid for 4-5 days.

Highest-priority critically important antimicrobials (HP-CIAs) such as fluoroquinolones or cefovecin (which has a 14 day duration of action) are inappropriate for this condition unless culture and sensitivity indicates they are the only option.

Avoiding the use of HP-CIAs in veterinary medicine is essential to preserve their effectiveness for treating severe, life-threatening infections in humans. These drugs are considered “last resort” treatments in human medicine, and their over-use in animals can lead to the development of resistant bacteria that may be transmitted to people. To mitigate the risk to public health, BSAVA/ SAMSoc PROTECT ME guidelines as well as the European Medicines Agency recommend that HP-CIAs (which include third generation cephalosporins and fluoroquinolones) should only be used when there are no other clinically effective alternatives available, to mitigate the risk to public health. 

What if an owner expects or requests antibiotics?

The perception of client pressure/expectation is cited as one of the main reasons for veterinarians to prescribe antibiotics. However, pet owners will hear similar stewardship messages from other healthcare providers such as doctors, dentists and pharmacists; often what they need is for their veterinary professional to confirm that antibiotics are not needed. Maintaining a consistent message ensures that owners can be reassured that antibiotics are not being prescribed in the best interests of their pet and of wider society.

Some resources that may support this conversation with pet owners include the BSAVA/SAMSoc No Antibiotic Required Prescription Form. This form can be freely downloaded from the BSAVA Library (No antibiotic required ‘non prescription’ form | BSAVA Library). You can also find a link to this resource and other useful resources further down this page.

How can our practice play a role in addressing antimicrobial resistance (AMR)?

Overuse or inappropriate use of antibiotics can increase AMR. It is vital that the companion animal sector does all it can to protect the efficacy of these important medicines by only using the right antibiotic at the right time,  and for the right duration (reduce, refine, replace) in order to protect the wellbeing of people, pets and the planet. 

Antimicrobial resistance (AMR) is projected to cause up to 39 million human deaths by 2050 if left unchecked and will make our jobs more difficult; there will be conditions we can no longer treat and surgeries we can no longer carry out. 

How can I engage my practice team to ensure a consistent approach to managing CBA or CFW?

  • Team discussion document – a resource to support veterinary and whole practice team discussions about CFW/CBA and explore ways to promote appropriate antibiotic use as a practice. This document provides practical advice on starting team discussions and agreeing a plan of action to assess and promote appropriate use in the treatment of CFW/CBA: CBA/CFW team discussion document.
  • Animation on CFW/CBA – this helpful animation created by The Royal Veterinary College (RVC) and VetCompass helps illustrate the opportunity that exists to reduce the use of antibiotics (antimicrobials) in the treatment of CFW/CBA. This is ideal to play at team meetings – VetCompass – Antimicrobial Stewardship Resources
  • Definitions and terminology – Cat fight wounds present in many ways hence it is important that the terminology is defined clearly and used consistently. This resource explains the difference between cat fight scratches, cat fight puncture wounds and cat bite abscesses. 
  • This flow chart is designed to help veterinary teams decide the most appropriate way to manage cat fight wounds and abscesses. It focuses on good wound care, drainage, and monitoring, and highlights when antibiotics may be indicated. The aim is to treat patients effectively while reducing unnecessary reliance on antibiotics. Download here. 
  • Supporting discussions around behaviour change: Agreeing a unified practice approach and understanding what the barriers to making changes might be is important. This might be a useful point of discussion at your team meetings: The COM-B Model for Behavior Change – The Decision Lab
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Learning resources:

Case study:

  • Explore an award-winning clinical audit project on the usage of antibiotics in cat bite abscess cases – Cat bite abscess audit – RCVS Knowledge. Veterinary surgeon Paul Stanley, an RCVS Advanced Practitioner at White Lodge Veterinary Surgery, focuses on improving clinical outcomes through quality improvement initiatives, including auditing the management of cat bite abscesses (CBAs). His research investigates if feline abscesses can be successfully treated without antibiotics.
  • A podcast is also available to listen to about the above case study: Knowledge Natter: Cat bite abscess audit – RCVS Knowledge

Useful industry resources and research:

Resources that practice teams can use to give to pet owners or display in the practice consulting and waiting rooms:

Auditing your activity:

  • RCVS Knowledge Antimicrobial Audit Reporting Template: this free audit tool helps teams gather data to make the right, evidence-based decisions for their patients. Clients can be invited to report on treatment outcomes, allowing teams to see how antimicrobial prescriptions can be improved for specific clinical presentations. Access the template here.

Feedback

  • If you have any feedback on the content of this page or have any suggestions for additional guidance and resources, please email rumacae@gmail.com