From the Guidelines
For bartonellosis affecting the eye, the recommended antibiotic is azithromycin, which can be used as an alternative treatment due to its clinical response and ease of use for patients who may have compliance issues with other medications. When considering treatment options for bartonellosis affecting the eye, it's crucial to prioritize medications that have shown efficacy against Bartonella species.
- The use of penicillins and first-generation cephalosporins is not recommended due to their lack of in vivo activity against Bartonella 1.
- Quinolones and TMP-SMX also have variable in vitro activity and inconsistent clinical responses, making them less favorable options for treatment 1.
- Azithromycin, on the other hand, offers a convenient dosing schedule and has been associated with clinical response, making it a suitable alternative for patients who may not adhere to more frequent dosing regimens of other antibiotics like doxycycline or erythromycin 1. Given the importance of effective treatment to prevent vision complications and the need for patient compliance, azithromycin emerges as a practical choice for the treatment of bartonellosis affecting the eye, especially in cases where compliance might be an issue. Key considerations in the treatment of ocular bartonellosis include the ability of the antibiotic to penetrate ocular tissues and its efficacy against the causative Bartonella species.
- While doxycycline and erythromycin are potential options, their use may be limited by dosing frequency and patient compliance.
- The choice of antibiotic should be guided by the most recent and highest quality evidence, with a focus on minimizing morbidity, mortality, and improving quality of life for the patient. In the context of real-life clinical practice, selecting azithromycin for the treatment of bartonellosis affecting the eye can help balance efficacy with the practical considerations of patient compliance and treatment adherence.
From the Research
Recommended Antibiotics for Bartonellosis Affecting the Eye
The following antibiotics have been recommended for the treatment of bartonellosis:
- Azithromycin or erythromycin
- Doxycycline
- Gentamicin
- Rifampin
- Ciprofloxacin 2
Treatment of Ocular Bartonella henselae Infection
A case study reported the use of doxycycline and aflibercept to treat central retinal vein occlusion associated with Bartonella henselae infection, resulting in an excellent clinical response and improvement in visual acuity 3
Antibiotic Susceptibility of Bartonella
Studies have shown that aminoglycosides, such as gentamicin, are effective against Bartonella henselae, while other antibiotics may not be bactericidal 4
FDA-Approved Drugs with Activity against Bartonella henselae
A high-throughput screen of an FDA-approved drug library identified several drugs with activity against stationary phase B. henselae, including pyrvinium pamoate, daptomycin, and aminoglycosides such as gentamicin and streptomycin 5