From the Guidelines
Cat scratch disease should be treated with azithromycin, following a dosing protocol of 500 mg on day 1, then 250 mg once daily for 4 additional days for patients weighing ≥45.5 kg, and 10 mg/kg on day 1, then 5 mg/kg on days 2–5 for those weighing <45.5 kg, as recommended by the Infectious Diseases Society of America 1.
Treatment Overview
The treatment of cat scratch disease with antimicrobial agents has had variable results, but azithromycin has shown promising outcomes in reducing lymph node size 1.
- The recommended dose of azithromycin is based on the patient's weight, with a loading dose followed by a maintenance dose for 4 days.
- For patients weighing ≥45.5 kg, the dose is 500 mg on day 1, then 250 mg once daily for 4 additional days.
- For patients weighing <45.5 kg, the dose is 10 mg/kg orally on day 1, then 5 mg/kg on days 2–5.
Diagnosis and Prevention
- Cat scratch disease is caused by the bacterium Bartonella henselae, transmitted through cat scratches or bites, particularly from kittens.
- Diagnosis may be difficult due to the fastidious nature of the organism, but serological testing, PCR, and Warthin-Starry silver stain of infected lymph node tissue can support the diagnosis 1.
- Prevention includes washing hands after handling cats, cleaning wounds promptly, and avoiding rough play with cats, especially kittens.
Management of Symptoms
- For pain and inflammation, over-the-counter medications like acetaminophen or ibuprofen can help.
- Most cases resolve without treatment within 2-4 months, but antibiotics can speed recovery and are recommended for severe cases or in immunocompromised patients.
From the Research
Treatment Options for Cat Scratch Disease
- The majority of cases of cat-scratch disease occurring in normal hosts do not require anti-infective therapy for resolution of infection 2.
- Antibiotics such as rifampin, ciprofloxacin, gentamicin, trimethoprim and sulfamethoxazole, clarithromycin, and azithromycin have been shown to be effective in treating cat-scratch disease 2, 3.
- Azithromycin has been associated with more rapid diminution in size of infected lymph nodes 2 and has been shown to speed recovery in one small study 4.
- Other antibiotics such as erythromycin and doxycycline have also been used to treat severe or persistent cases of cat-scratch disease 5.
- A study on pediatric patients with cat scratch disease found that azithromycin and trimethoprim/sulfamethoxazole were the most frequently prescribed antibiotics and were effective in treating the disease 6.
Antibiotic Effectiveness
- Azithromycin and trimethoprim/sulfamethoxazole have been shown to be effective in treating cat-scratch disease, with resolution and improvement of symptoms observed in 51.4% and 61.5% of patients, respectively 6.
- The effectiveness of azithromycin and trimethoprim/sulfamethoxazole was comparable, suggesting that either antibiotic may be used to treat cat-scratch disease 6.
- Ciprofloxacin has also been shown to be effective in treating cat-scratch disease, with all five patients in one study experiencing dramatic improvement in symptoms within a few days 3.