Antimicrobial Therapy for Disease Caused by Bartonella Species in Adults
| Disease | Antimicrobial Therapy |
|---|---|
| Typical cat-scratch disease | Not routinely indicated; for pts with extensive lymphadenopathy, consider azithromycin (500 mg PO on day 1, then 250 mg PO qd for 4 days) |
| Cat-scratch disease retinitis | Doxycycline (100 mg PO bid) plus rifampin (300 mg PO bid) for 4-6 weeks |
| Other atypical cat-scratch disease manifestationsa | As per retinitis; treatment duration should be individualized |
| Trench fever or chronic bacteremia with B. quintana | Gentamicin (3 mg/kg IV qd for 14 days) plus doxycycline (200 mg PO qd or 100 mg PO bid for 6 weeks) |
| Suspected Bartonella endocarditis | Gentamicinb (1 mg/kg IV q8h for ≥14 days) plus doxycycline (100 mg PO/IV bid for 6 weeksc) plus ceftriaxone (2 g IV qd for 6 weeks) |
| Confirmed Bartonella endocarditis | As for suspected Bartonella endocarditis minus ceftriaxone |
| Bacillary angiomatosis | Erythromycind (500 mg PO qid for 3 months) |
| or | |
| Doxycycline (100 mg PO bid for 3 months) | |
| Bacillary peliosis | Erythromycind (500 mg PO qid for 4 months) |
| or | |
| Doxycycline (100 mg PO bid for 4 months) | |
| Carrin's disease | |
| Oroya fever | Chloramphenicol (500 mg PO/IV qid for 14 days) plus another antibiotic (β-lactam preferred) |
| or | |
| Ciprofloxacin (500 mg PO bid for 10 days) | |
| Verruga peruana | Rifampin (10 mg/kg PO qd, to a maximum of 600 mg, for 14 days) |
| or | |
| Streptomycin (15-20 mg/kg IM qd for 10 days) |
aData on treatment efficacy for encephalitis and hepatosplenic cat-scratch disease are lacking. Therapy similar to that given for retinitis is reasonable.
bSome experts recommend gentamicin at 3 mg/kg IV qd. If gentamicin is contraindicated, rifampin (300 mg PO bid) can be added to doxycycline for documented Bartonella endocarditis.
cSome experts recommend extending oral doxycycline therapy for 3-6 months.
dOther macrolides are probably effective and may be substituted for erythromycin or doxycycline.
Source: Recommendations are modified from JM Rolain et al: Antimicrob Agents Chemother 48:1921, 2004.