From the Guidelines
Disseminated bartonellosis should be treated with a combination of antibiotics, with doxycycline (100mg twice daily) plus gentamicin (3 mg/kg per 24 h IV/IM in 3 equally divided doses) for 4-6 weeks being the preferred regimen, as recommended by the 2015 update from the American Heart Association 1.
Treatment Considerations
- The treatment duration may extend to 3-4 months for immunocompromised patients.
- Severely ill patients should be hospitalized for intravenous antibiotics initially.
- Blood cultures using specialized techniques are essential for diagnosis, along with PCR testing and serology.
Causative Species and Transmission
- Bartonella henselae and B. quintana are the most common causative species.
- Transmission occurs through cat scratches, bites, or body lice.
High-Risk Individuals
- Immunocompromised individuals, especially those with HIV, are at higher risk for disseminated disease and require more aggressive treatment and monitoring for relapse.
Alternative Treatment Options
- Rifampin (600 mg/24 h PO/IV in 2 equally divided doses) can be used as an alternative to gentamicin if it cannot be given, as suggested by the 2005 guidelines from the American Heart Association 1.
- Long-term suppression of infection with erythromycin or doxycycline should be considered for patients with relapse or reinfection, as recommended by the 1999 USPHS/IDSA guidelines 1.
From the FDA Drug Label
Bartonellosis due to Bartonella bacilliformis. The FDA drug label mentions Bartonella bacilliformis as a cause of infection that can be treated with doxycycline, but it does not specifically address disseminated bartonella.
- The label does not provide information on the treatment of disseminated bartonella. 2
From the Research
Disseminated Bartonella
- Disseminated Bartonella infections can cause a range of clinical manifestations, from benign and self-limited to severe and life-threatening disease 3.
- The severity of Bartonella infection correlates with the patient's immune status, and clinical conditions associated with Bartonella spp. include local lymphadenopathy, bacteraemia, endocarditis, and tissue colonisation resulting in bacillary angiomatosis and peliosis hepatis 3.
- Treatment of disseminated Bartonella infections is challenging, and no single treatment is effective for all Bartonella-associated diseases 3, 4.
- A retrospective observational multicenter study found that treatment failure occurred in 39% of patients with disseminated Bartonella spp. infections, and the most common treatment regimen was doxycycline with rifampin 4.
Treatment Options
- Antibiotics such as azithromycin, doxycycline, gentamicin, rifampin, and ciprofloxacin are generally effective in acute infection, but treatment of chronic infection remains problematic 5.
- The combination of azlocillin and azithromycin may be an effective drug combination for the treatment of Bartonellosis, especially in intracellular growth conditions 5.
- Current clinical practice for the treatment of bartonellosis relies mostly on expert opinion and antimicrobial susceptibility data, and randomized controlled trials are needed to compare different treatment options 6.
Diagnosis and Epidemiology
- Diagnosis of disseminated Bartonella infections can be challenging due to the limitations of tissue and blood cultures, and molecular testing (polymerase chain reaction, PCR) and cell-free DNA have provided an avenue for diagnoses 4.
- The epidemiology of Bartonella infections is complex, with a diverse range of animal reservoir hosts and arthropod vectors, and a One Health approach is needed to properly address animal health, public health, and environmental factors that influence the distribution and transmission of these bacteria 7.