From the Guidelines
Cat scratch disease should be treated with azithromycin as the first-line medication, with a recommended dose of 500mg on day 1 followed by 250mg daily for 4 additional days for patients weighing >45kg, and 10mg/kg on day 1 followed by 5mg/kg daily for 4 additional days for patients weighing <45kg, as supported by the Infectious Diseases Society of America guidelines 1.
Treatment Overview
The treatment of cat scratch disease (CSD) focuses on managing symptoms and preventing complications, with azithromycin being the preferred antibiotic due to its efficacy in reducing lymph node size and alleviating symptoms 1.
- For patients weighing ≥45kg, the recommended dose is 500mg on day 1, then 250mg once daily for 4 additional days.
- For patients weighing <45kg, the dose is 10mg/kg orally on day 1, then 5mg/kg on days 2–5.
Symptom Management
In addition to antibiotic treatment, symptom management is crucial, including:
- Over-the-counter pain relievers like acetaminophen or ibuprofen to manage pain and fever.
- Warm compresses applied to swollen lymph nodes to provide relief.
- Keeping the scratch wound clean and monitoring for signs of worsening infection, such as increasing redness, swelling, or fever.
Disease Course and Complications
CSD is typically a self-limiting disease, with most patients recovering completely within a few weeks, even without antibiotic treatment 1. However, medications can speed recovery and prevent complications, such as suppurating lymph nodes or extranodal disease, which can occur in a small percentage of cases.
- The disease course varies, but lymphadenopathy generally resolves within 1–6 months.
- Extranodal disease, such as central nervous system, liver, spleen, bone, or lung involvement, develops in ≤2% of cases.
- Bacillary angiomatosis, a condition that can occur in immunocompromised patients, especially those with AIDS, can be caused by B. henselae or Bartonella quintana.
From the FDA Drug Label
Doxycycline is indicated for the treatment of infections caused by the following gram-negative microorganisms: ... Bartonellosis due to Bartonella bacilliformis. The treatment for Bartonellosis (also known as Cat Scratch Disease (CSD)) is doxycycline 2.
- Key points:
- Doxycycline is indicated for the treatment of Bartonellosis due to Bartonella bacilliformis.
- The drug label does not specify treatment for other Bartonella species that may cause CSD.
From the Research
Treatment for Cat Scratch Disease (CSD)
The treatment for Cat Scratch Disease (CSD), also known as Bartonellosis, is primarily focused on managing symptoms, as most cases are self-limited and do not require antibiotic treatment 3, 4, 5.
- Antibiotic treatment may be considered in some cases, with azithromycin shown to speed recovery in one small study 3, 4, 5.
- Other antibiotics that have been used to treat CSD include gentamicin, rifadin, ciprofloxacin, clarithromycin, bactrim, and mitramycin 6.
- In some cases, resection of swelling lymph nodes may be necessary 6.
- The use of antibiotic therapy remains controversial, and the decision to treat should be made on a case-by-case basis 7.
Diagnosis and Clinical Features
Diagnosis of CSD is typically based on a history of exposure to cats, negative studies for other similar diseases, characteristic histopathologic features, and results of an indirect immunofluorescence test 7.