Bartonellosis medical therapy

Bartonellosis Microchapters
Home
Patient Information
Overview
Historical Perspective
Pathophysiology
Causes
Differentiating Bartonellosis from other Diseases
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Primary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Bartonellosis medical therapy On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Bartonellosis medical therapy All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Bartonellosis medical therapy
CDC on Bartonellosis medical therapy
Bartonellosis medical therapy in the news
Blogs on Bartonellosis medical therapy
Directions to Hospitals Treating Bartonellosis
Risk calculators and risk factors for Bartonellosis medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The mainstay of therapy for bartonellosis is antimicrobial therapy.

Medical Therapy

Pharmacotherapy

Treatment of Bartonellosis are specific for each species. Azithromycin, Doxycycline and Erythromycin are commonly used to treat Bartonellosis. While Bartonella species are susceptible to a number of standard antibiotics in vitro—macrolides and tetracyclines, for example—the efficacy of antibiotic treatment in immunocompetent individuals is uncertain.[1] Immunocompromised patients should be treated with antibiotics because they are particularly susceptible to systemic disease and bacteremia. Drugs of particular effectiveness include Trimethoprim-sulfamethoxazole, Gentamicin, Ciprofloxacin, and Rifampin; B. henselae is generally resistant to Penicillin, Amoxicillin, and Nafcillin.[1]

Treatment of infections caused by Bartonella species.

Disease	Adults	Children
Cat scratch disease	no recommendation	no recommendation
Retinitis	Doxycycline + Rifampin	unknown
Trench fever or chronic bacteremia by B.quintana	Doxycycline + Gentamicin	unknown
Bacillary angiomatosis	Erythromycin or Doxycycline	Erythromycin
Peliosis hepatis	Erythromycin or Doxycycline	Erythromycin
Endocarditis	Doxycycline + Gentamicin + Rifampin or Ceftriaxone + Gentamicin
Carrión´s disease (acute phase)	Ciprofloxacin or Chloramphenicol	Chloramphenicol + beta-lactam
Carrión´s disease (chronic phase: Verruga peruana)	Rifampin or macrolides	Rifampin or macrolides

Anti microbial regimen

• Bartonella

• 1. Bartonella quintana

• 1.1 Acute or chronic infections without endocarditis

• Preferred regimen: Doxycycline 200 mg PO qd or 100 mg bid for 4 weeks AND Gentamicin 3 mg/kg IV qd for the first 2 weeks

• 1.2 Endocarditis

• Preferred regimen: Gentamicin 3 mg/kg/day IV q8h for 14 days AND Ceftriaxone 2 g IV q24h for 6 weeks ± Doxycycline 100 mg PO bid for 6 weeks

• 2. Bartonella elizabethae

• 2.1 Endocarditis

• Preferred regimen: Gentamicin 3 mg/kg/day IV q8h for 14 days AND Ceftriaxone 2 g IV q24h for 6 weeks ± Doxycycline 100 mg PO bid for 6 weeks

• 3. Bartonella bacilliformis

• 3.1 Oroya fever

• Preferred regimen: Ciprofloxacin 500 mg PO bid for 14 days
• Note: If severe disease, add Ceftriaxone 1 g IV qd for 14 days

• 3.2 Verruga peruana

• Preferred regimen: Azithromycin 500 mg PO qd for 7 days
• Alternative regimen (1): Rifampin 600 mg PO qd for 14-21 days
• Alternative regimen (2): Ciprofloxacin 500 mg bid for 7-10 days

• 4. Bartonella henselae

• 4.1 Cat scratch disease

• No treatment recommended for typical cat scratch disease, consider treatment if there is an extensive lymphadenopathy
• 4.1.1 If extensive lymphadenopathy

• Preferred regimen (1) (pediatrics): Azithromycin 500 mg PO on day 1 THEN 250 mg PO qd on days 2 to 5
• Preferred regimen (2) (adults): Azithromycin 1 g PO at day 1 THEN 500 mg PO for 4 days

• 4.2 Endocarditis

• Preferred regimen: Gentamicin 3 mg/kg/day IV q8h for 14 days AND Ceftriaxone 2 g/day IV for 6weeks ± Doxycycline 100 mg PO bid for 6 weeks

• 4.3 Retinitis

• Preferred regimen: Doxycycline 100 mg bid AND Rifampin 300 mg bid PO for 4-6 weeks

• 4.4 Bacillary angiomatosis

• Preferred regimen (1): Erythromycin 500 mg PO qid for 2 months at least
• Preferred regimen (2): Doxycycline 100 mg PO bid for 2 months at least

• 4.5 Bacillary Pelliosis

• Preferred regimen (1): Erythromycin 500 mg PO qid for 4 months at least
• Preferred regimen (2): Doxycycline 100 mg PO bid for 4 months at least