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Bartonellosis Treatment & Management

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Bartonellosis Treatment & Management

Author: Kassem A Hammoud, MD; Chief Editor: Burke A Cunha, MD more...
Updated: May 30, 2014

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. Rifampin in combination with another drug, or
the use of gentamicin, may be considered in some situations.
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.[39]
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.
A meta-analysis found 2 studies; one was a randomized controlled study and the other was an
observational study. No antibiotic regimen was shown to be beneficial in improving the cure rate or
time to achieve cure.[40]
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 ciprofloxacin or
doxycycline could be used.
If the initial phase (Oroya fever) is not treated, mortality can be higher than 40%.[41]
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."[42]

Consultations
Infectious diseases specialist
Possible consultation with a surgeon for biopsy or drainage

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 Adjunct Assistant Professor, University of Nebraska Medical Center
College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Medscape Salary Employment
Joseph F John Jr, MD, FACP, FIDSA, FSHEA Clinical Professor of Medicine, Molecular Genetics and
Microbiology, Medical University of South Carolina College of Medicine; Associate Chief of Staff for Education,
Ralph H Johnson Veterans Affairs Medical Center
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
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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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