What is the treatment for cat scratch disease (tx)?

From the Guidelines

The treatment for cat scratch disease should involve azithromycin as the first-line antibiotic, with a recommended dose of 500mg on day 1, followed by 250mg 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 supported by the Infectious Diseases Society of America guidelines 1.

Key Considerations

• The disease course varies, but lymphadenopathy generally resolves within 1–6 months, and in about 10% of cases, the nodes suppurate 1.
• Extranodal disease develops in ≤2% of cases, and Bartonella henselae causes most cases of cat scratch disease in immunocompetent hosts 1.
• Diagnosis of Bartonella infections may be difficult, but serological testing, PCR, and a positive Warthin-Starry silver stain of infected lymph node tissue can support the diagnosis 1.

Treatment Approach

• Azithromycin has shown variable but rarely dramatic results in treating cat scratch disease, with one study demonstrating lymph node size regression by 80% at 30 days more frequently in azithromycin-treated patients (P = .02) 1.
• The recommended dosing protocol for azithromycin is:
  • Patients >45 kg: 500 mg on day 1 followed by 250 mg for 4 additional days 1.
  • Patients <45 kg: 10 mg/kg on day 1 and 5 mg/kg for 4 more days 1.

Additional Management

• Supportive care, including analgesics like acetaminophen or ibuprofen, can help manage pain and fever in mild to moderate cases.
• Needle aspiration may provide relief for patients with lymph node involvement causing significant pain.
• Immunocompromised patients may require longer treatment courses and intravenous antibiotics if severely affected.

From the Research

Treatment for Cat Scratch Disease

The treatment for cat scratch disease (tx) typically involves the use of antibiotics, although in some cases, the disease may resolve on its own without treatment.

• The most effective antibiotics for treating cat scratch disease include rifampin, ciprofloxacin, gentamicin, trimethoprim and sulfamethoxazole, clarithromycin, and azithromycin 2.
• Azithromycin has been shown to be particularly effective in reducing the size of infected lymph nodes, with one study finding that azithromycin therapy was associated with more rapid diminution in size of infected lymph nodes compared to placebo 3.
• Other antibiotics, such as erythromycin and doxycycline, may also be effective in treating cat scratch disease, particularly in severe or persistent cases 4.
• In some cases, treatment with azithromycin may need to be extended or combined with other antibiotics, such as rifampicin or doxycycline, or with steroids 5.
• Ciprofloxacin has also been shown to be effective in treating cat scratch disease in adults, with one study reporting dramatic improvement in symptoms within a few days of treatment 6.

Antibiotic Treatment Options

The choice of antibiotic treatment for cat scratch disease may depend on the severity of the disease and the patient's overall health.

• For uncomplicated cases, azithromycin or other macrolides may be effective 3, 5.
• For more severe cases, or for patients with underlying health conditions, other antibiotics such as rifampicin, ciprofloxacin, or gentamicin may be necessary 2, 6.
• In some cases, treatment with multiple antibiotics may be necessary to effectively manage the disease 5.