What is the recommended antibiotic regimen for prophylaxis of cat scratch disease (Cat Scratch Disease, CSD)?

From the Guidelines

For cat scratch disease prophylaxis, antibiotic treatment with azithromycin 500 mg on day 1 followed by 250 mg daily for 4 more days is recommended for immunocompromised patients at high risk of complications, as supported by the 2014 update by the Infectious Diseases Society of America 1. When considering antibiotic regimen prophylaxis for cat scratch disease, it's crucial to weigh the risks and benefits, particularly in immunocompetent versus immunocompromised individuals.

• The disease course varies, but lymphadenopathy generally resolves within 1–6 months in immunocompetent hosts, making routine antibiotic prophylaxis unnecessary for this group 1.
• However, for immunocompromised patients, the risk of complications such as bacillary angiomatosis is higher, necessitating a more aggressive approach with antibiotic prophylaxis.
• Azithromycin has shown promise in reducing lymph node size in cat scratch disease, with a study demonstrating an 80% regression in lymph node size at 30 days in azithromycin-treated patients compared to placebo 1.
• The recommended dose of azithromycin for patients weighing ≥45.5 kg is 500 mg on day 1, then 250 mg once daily for 4 additional days; for those weighing <45.5 kg, the dose is 10 mg/kg orally on day 1, then 5 mg/kg on days 2–5, as outlined in the guidelines 1.
• Proper wound care, including thorough cleaning with soap and water, application of antiseptic, and monitoring for signs of infection, remains a critical component of managing cat scratch disease, regardless of antibiotic prophylaxis 1.

From the Research

Antibiotic Regimen for Cat Scratch Disease

• The majority of cases of cat-scratch disease do not require anti-infective therapy for resolution of infection 2, 3, 4.
• For severe or persistent cases, several antibiotics have been shown to be effective, including:
  • Azithromycin, which has been associated with more rapid diminution in size of infected lymph nodes 2, 4.
  • Rifampin, ciprofloxacin, gentamicin, trimethoprim and sulfamethoxazole, clarithromycin 2.
  • Erythromycin and doxycycline 3.
• In cases of uncomplicated cat-scratch disease, only 12.5% of clinicians chose the recommended treatment option of analgesics and monitoring, while 71.4% selected antibiotics 5.

Prevention and Management

• Flea control is crucial to minimize transmission risk 6.
• Patients should be counseled to speak with their pets' veterinarian about testing and treating infected animals with doxycycline and a quinolone 6.
• Clinicians should be aware of the strategies for minimizing Bartonella transmission risk and cognizant of the One Health approach for managing zoonoses 6.