From the Guidelines
The treatment of systemic bartonellosis typically involves a combination of antibiotics for 2-4 weeks, with doxycycline 100mg twice daily being the first-line therapy for most patients, as recommended by the Infectious Diseases Society of America 1. The choice of antibiotic depends on the specific species of Bartonella, with doxycycline or azithromycin being considered for Bartonella henselae 1. For severe infections or immunocompromised patients, combination therapy is recommended, often adding rifampin 300mg twice daily or gentamicin 5mg/kg daily (divided into 3 doses) 1. Some key points to consider when treating systemic bartonellosis include:
- The use of antibiotics with good intracellular penetration, such as doxycycline and azithromycin, is essential for effective treatment 1.
- Treatment duration should be extended to 4-6 weeks for patients with endocarditis or osteomyelitis, and surgical intervention may be necessary for complicated cases 1.
- Long-term suppression of infection with erythromycin or doxycycline should be considered for patients with relapse or reinfection 1. It is also important to note that Bartonella bacteria are intracellular pathogens that can persist in erythrocytes and endothelial cells, which is why antibiotics with good intracellular penetration are essential for effective treatment. Clinical improvement is typically seen within 48-72 hours of initiating appropriate therapy, though complete resolution may take longer in immunocompromised individuals. In cases of suspected Bartonella endocarditis, treatment with ceftriaxone sodium and gentamicin sulfate, with or without doxycycline, is recommended 1.
From the FDA Drug Label
Bartonellosis due to Bartonella bacilliformis.
- Doxycycline is indicated for the treatment of bartonellosis caused by Bartonella bacilliformis 2.
- The treatment of systemic bartonellosis can be done with doxycycline.
From the Research
Treatment Options for Systemic Bartonellosis
- The current standard of care antibiotics for acute infection include azithromycin or erythromycin, doxycycline, gentamicin, rifampin, and ciprofloxacin 3.
- For chronic infection, treatment remains problematic, but a combination of azlocillin and azithromycin may be effective 3.
- Gentamicin and doxycycline are recommended for the treatment of bacteraemia, while gentamicin in combination with doxycycline is considered the best treatment regimen for endocarditis 4.
- Erythromycin is the first-line antibiotic therapy for the treatment of angioproliferative lesions, and rifampicin or streptomycin can be used to treat verruga peruana 4.
- A systematic review and meta-analysis found that antibiotics did not significantly affect the cure rate or time to achieve cure for cat scratch disease, but gentamicin and doxycycline significantly increased the resolution rate for chronic bacteremia 5.
Identified FDA-Approved Drugs with Activity against Bartonella henselae
- A high-throughput screen of an FDA-approved drug library identified 110 drug candidates with better activity against stationary phase B. henselae than ciprofloxacin 6.
- The top drug candidates included pyrvinium pamoate, daptomycin, methylene blue, azole drugs, aminoglycosides, and others, which had higher activity than the current frontline antibiotic erythromycin 6.
- Pyrvinium pamoate, daptomycin, methylene blue, clotrimazole, and gentamicin and streptomycin had the capacity to completely eradicate stationary phase B. henselae after 3-day drug exposure in subculture studies 6.
Antibiotic Susceptibility and Resistance
- Bartonella species have unique antibiotic susceptibility patterns, and treatment failure can occur due to antibiotic resistance 7.
- The molecular mechanism of antibiotic resistance in Bartonella species is complex and involves several factors, including efflux pumps and target modification 7.
- Antibiotic treatment recommendations for Bartonella infections vary depending on the specific disease and the patient's immune status 4, 7.