What is the treatment for cat scratch disease?

From the Guidelines

The treatment for cat scratch disease is azithromycin, with a recommended dose of 500 mg on day 1, followed by 250 mg for 4 additional days for patients weighing >45 kg, and 10 mg/kg on day 1, followed by 5 mg/kg for 4 more days for patients weighing <45 kg. This recommendation is based on the guidelines from the Infectious Diseases Society of America, as outlined in the 2014 update 1. The use of azithromycin has been shown to result in significant regression of lymph node size, with an 80% reduction in size at 30 days compared to placebo 1.

Key Considerations

• The disease is caused by the bacterium Bartonella henselae, which is transmitted through cat scratches or bites.
• Symptoms typically include a papule or pustule at the site of the scratch, followed by lymphadenopathy, which usually resolves within 1-6 months.
• In some cases, lymph nodes may suppurate, and extranodal disease can occur, although this is rare.
• Diagnosis can be challenging 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.

Treatment Approach

• For mild cases, supportive care, including rest, over-the-counter pain relievers, and warm compresses, may be sufficient.
• For more severe cases, antibiotic therapy with azithromycin is recommended, with the dose and duration as outlined above.
• Immunocompromised patients may require longer treatment courses, and alternative antibiotics, such as ciprofloxacin, trimethoprim-sulfamethoxazole, or rifampin, may be considered in certain cases.

Prevention

• Preventing future infections involves washing cat scratches promptly with soap and water, avoiding rough play with cats, and keeping cats free of fleas.

From the Research

Treatment Overview

• The treatment for cat scratch disease (CSD) typically involves antibiotic therapy, although the majority of cases 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 CSD 2, 3.

Antibiotic Treatment

• Azithromycin therapy has been associated with more rapid diminution in size of infected lymph nodes 2.
• Trimethoprim-sulphamethoxazole, ciprofloxacin, or azithromycin are recommended for treatment of complicated CSD, with gentamicin being reserved for severely ill patients 3.
• A study found that 21 patients responded to 5 days of azithromycin treatment, while 8 patients required extension of treatment to 10-14 days 4.

Specific Treatment Regimens

• Rifampicin with or without doxycycline may be given to patients who do not respond to azithromycin 4.
• Steroids may be given to patients with severe symptoms 4.
• Erythromycin and doxycycline have also been shown to be effective in treating CSD 5.

Treatment Considerations

• The decision to treat CSD with antibiotics should be based on the severity of symptoms and the patient's overall health status 2, 3.
• Treatment should be individualized, taking into account the patient's specific needs and circumstances 4, 5.
• In cases of regional lymphadenopathy, especially axillary, not responding to nonspecific antibiotics, CSD should be suspected, and cat contact history, serological, and ultrasonographic findings can be useful for diagnosis 4.