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 once a day for 4 days) |
| Cat-scratch disease neuroretinitis | Value of systemic antibiotics is controversial, particularly when visual acuity is not significantly compromised. For more severe cases, doxycycline (100 mg PO bid) plus rifampin (300 mg PO bid) for 4-6 weeks is given. Consider adding systemic glucocorticoids. |
| Other atypical cat-scratch disease manifestationsa | As per neuroretinitis. Treatment duration should be individualized. |
| Trench fever or chronic bacteremia with B. quintana | Gentamicin (3 mg/kg IV once a day for 14 days) plus doxycycline (200 mg PO once a day 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 once a day 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) |
| Carrion'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 once a day, to a maximum of 600 mg, for 14 days) or Streptomycin (15-20 mg/kg IM once a day for 10 days) |
a Data on treatment efficacy for encephalitis and hepatosplenic cat-scratch disease are lacking. Therapy similar to that given for neuroretinitis is reasonable.
b Some experts recommend gentamicin at 3 mg/kg IV once a day. If gentamicin is contraindicated, rifampin (300 mg PO bid) can be added to doxycycline for documented Bartonella endocarditis.
c Some experts recommend extending oral doxycycline therapy for 3-6 months.
d Other macrolides are probably effective and may be substituted for erythromycin or doxycycline.
Source: Rolain JM et al: Antimicrob Agents Chemother 48:1921, 2004. Amended with permission from American Society of Microbiology.