Bartonellosis Treatment & Management

  • Author: Kassem A Hammoud, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Dec 23, 2010
 

Medical Care

  • Catscratch disease
    • Several therapies have been successful. Whether therapy should be provided at all is unclear because catscratch disease is ordinarily a self-limited condition that lasts weeks to months. Therapy is typically provided because of patient concerns about tender nodes and because early treatment is believed to reduce the possibility of disseminated complications.
    • Cost-effective pharmaceutical choices include erythromycin or doxycycline. Azithromycin has been shown to be more effective than placebo in resolving lymphadenopathy; some consider azithromycin to be the drug of choice.
    • If the initial therapeutic choice appears unsuccessful after 2-3 weeks, consider switching to azithromycin, co-trimoxazole, or a quinolone antibiotic. Neither penicillins nor cephalosporins (other than third-generation cephalosporins) are active against these organisms. Rifampin in combination with another drug, or the use of gentamicin, may be considered.
    • The usual duration of therapy is 3-6 weeks. Patients who are bacteremic require at least 4 weeks of therapy. Patients with HIV and other immunocompromising diseases require more prolonged therapy. Patients who have vegetations due to bartonellosis often require valve replacement. At least initially, an aminoglycoside should be included in the treatment of endocarditis.[30]
    • No definitive therapeutic study of CNS bartonellosis or neuroretinitis has been performed, but treating these patients seems prudent. Agents that penetrate the CNS or eye are favored, including doxycycline or azithromycin possibly with rifampin, clarithromycin, or a newer fluoroquinolone antibiotic. A combination of 2 drugs is favored because this may speed healing and because no single agent has been found to cure all cases in which it was used. Data from the literature do not support the use of corticosteroids.
  • B quintana infection: For bacteremia or trench fever, patients should be administered a trial of doxycycline 100 mg orally twice daily for at least 4 weeks. A longer duration of therapy should be considered in immunocompromised patients. In addition, when the liver or other organs are involved, the duration of therapy is typically longer.
  • Bacillary angiomatosis
    • In persons with AIDS and bacillary angiomatosis, the primary pharmaceutical choices include erythromycin, doxycycline, or more expensive drugs such as azithromycin, clarithromycin, or a fluoroquinolone.
    • Doxycycline combined with rifampin is effective in patients with severe disease. Such patients often require extended treatment (≥3 mo).
  • B bacilliformis infection
    • Chloramphenicol has been established as therapy in developing countries, but doxycycline could be used.
    • Duration of therapy should be at least 1 week, and longer courses may be required.
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Surgical Care

In an editorial entitled "Bartonellosis: light and shadows in diagnostic and therapeutic issues" in Clinical Microbiology and Infection (2005), Manfredi et al wrote, "The role of surgical debridement and the unpredictable activity of antimicrobial agents warrant further investigation." The authors go on to point out that "The need for, selection and duration of antimicrobial therapy for CSD remain contentious. Suppurative nodes that become tense and painful should be drained, but incision of non-suppurative lesions should be avoided, as chronic draining fistulae or compromised healing may result."[31]

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Consultations

  • Infectious diseases specialist
  • Possible consultation with a surgeon for biopsy or drainage
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Contributor Information and Disclosures
Author

Kassem A Hammoud, MD  Assistant Professor, Division of Infectious Diseases, University of Kansas Medical Center

Kassem A Hammoud, MD is a member of the following medical societies: Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Coauthor(s)

Daniel R Hinthorn, MD  Director, Division of Infectious Diseases, Professor, Departments of Internal Medicine, Pediatrics and Family Medicine, University of Kansas

Daniel R Hinthorn, MD is a member of the following medical societies: American Academy of Family Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Brian Edwards, MD  Consulting Staff, Department of Infectious Diseases, Cotton O'Neil Clinic

Disclosure: Nothing to disclose.

Specialty Editor Board

Larry I Lutwick, MD  Professor of Medicine, State University of New York, Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus

Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Joseph F John Jr, MD, FACP, FIDSA, FSHEA  Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

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