Bartonellosis medical therapy

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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.[1][2]

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

  • 1. Bartonella quintana
  • 1.1 Acute or chronic infections without endocarditis[4]
  • 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[5]
  • 2. Bartonella elizabethae
  • 2.1 Endocarditis[5]
  • 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[6]
  • 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[7]
  • 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
  • 4.3 Retinitis
  • 4.4 Bacillary angiomatosis[8]
  • 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[8]
  • 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

References

  1. Rolain JM, Brouqui P, Koehler JE, Maguina C, Dolan MJ, Raoult D (2004). "Recommendations for treatment of human infections caused by Bartonella species". Antimicrob. Agents Chemother. 48 (6): 1921–33. doi:10.1128/AAC.48.6.1921-1933.2004. PMC 415619. PMID 15155180. Unknown parameter |month= ignored (help)
  2. Blanco JR, Raoult D (2005). "[Diseases produced by Bartonella]". Enferm. Infecc. Microbiol. Clin. (in Spanish; Castilian). 23 (5): 313–9, quiz 320. PMID 15899181. Unknown parameter |month= ignored (help)
  3. Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  4. Foucault C, Raoult D, Brouqui P (2003). "Randomized open trial of gentamicin and doxycycline for eradication of Bartonella quintana from blood in patients with chronic bacteremia". Antimicrob Agents Chemother. 47 (7): 2204–7. PMC 161867. PMID 12821469.
  5. 5.0 5.1 Baddour LM, Wilson WR, Bayer AS, Fowler VG, Bolger AF, Levison ME; et al. (2005). "Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America". Circulation. 111 (23): e394–434. doi:10.1161/CIRCULATIONAHA.105.165564. PMID 15956145.
  6. Bradley JS, Jackson MA, Committee on Infectious Diseases, American Academy of Pediatrics. The use of systemic and topical fluoroquinolones. Pediatrics 2011; 128:e1034.
  7. Rolain JM, Brouqui P, Koehler JE, Maguina C, Dolan MJ, Raoult D (2004). "Recommendations for treatment of human infections caused by Bartonella species". Antimicrob Agents Chemother. 48 (6): 1921–33. doi:10.1128/AAC.48.6.1921-1933.2004. PMC 415619. PMID 15155180.
  8. 8.0 8.1 Spach DH, Koehler JE (1998). "Bartonella-associated infections". Infect Dis Clin North Am. 12 (1): 137–55. PMID 9494835.



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