From the Guidelines
Azithromycin is the recommended treatment for cat scratch disease, with a dose 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 orally on day 1, then 5 mg/kg on days 2–5 for those weighing <45.5 kg. This treatment is based on a single, double-blind placebo-controlled study that showed significant reduction in lymph node size in patients treated with azithromycin compared to placebo 1. The diagnosis of cat scratch disease can be challenging due to the fastidious nature of the causative organism, Bartonella henselae, but serological testing, PCR, and Warthin-Starry silver stain of infected lymph node tissue can support the diagnosis 1. It is essential to note that treatment with antimicrobial agents has had variable results, but azithromycin has shown promising outcomes 1.
Some key points to consider in the management of cat scratch disease include:
- The disease course varies, but lymphadenopathy generally resolves within 1–6 months 1
- Extranodal disease can occur in ≤2% of cases, affecting organs such as the central nervous system, liver, spleen, bone, and lung 1
- Bacillary angiomatosis, a condition related to Bartonella infections, can occur in immunocompromised patients, especially those with AIDS 1
- A positive Warthin-Starry silver stain of infected lymph node tissue can confirm the diagnosis, although it cannot differentiate species of Bartonella 1
In clinical practice, it is crucial to prioritize the treatment of cat scratch disease with azithromycin, as it has shown significant benefits in reducing lymph node size and improving patient outcomes 1.
From the Research
Treatment Overview
- The majority of cases of cat-scratch disease (CSD) are self-limited and do not require antibiotic treatment 2, 3, 4, 5.
- However, in some cases, antibiotic therapy may be necessary, especially in severe or persistent cases 2, 3, 4, 5.
Antibiotic Options
- Azithromycin has been shown to speed recovery in some cases of CSD 2, 3.
- Other antibiotics that have been used to treat CSD include:
Special Considerations
- Immunocompromised individuals may require antibiotic therapy to prevent severe complications such as bacillary angiomatosis, bacillary peliosis, and relapsing bacteremia with fever syndrome 2, 4.
- In cases of atypical or severe CSD, such as encephalopathy, retinitis, or hepatosplenic infection, antibiotic therapy may be necessary 4, 5.