From the Guidelines
The most effective treatment for Bartonella infection is doxycycline (100mg twice daily for 4 weeks) plus gentamicin (3 mg/24 h) i.v. for 2 weeks, as recommended by the 2015 ESC guidelines for the management of infective endocarditis 1.
Treatment Options
- For uncomplicated Bartonella infections, doxycycline (100mg twice daily for 2-4 weeks) is often the first-line treatment.
- Alternatives include azithromycin (500mg on day one, then 250mg daily for 4-5 days) as supported by a single, double-blind placebo-controlled study involving 29 patients, 14 of whom received azithromycin, which showed that the lymph node size regressed by 80% at 30 days more frequently in the azithromycin-treated patients (P = .02) 1.
- For more severe infections, such as those involving the heart or central nervous system, combination therapy may be necessary, often including doxycycline plus rifampin (300mg twice daily) for 4-6 weeks.
Key Considerations
- Immunocompromised patients typically require longer treatment courses, sometimes 3-4 months.
- During treatment, patients should avoid sun exposure when taking doxycycline due to increased photosensitivity.
- Patients should complete the full course of antibiotics even if symptoms improve, and follow up with their healthcare provider to ensure the infection has resolved.
- Bartonella bacteria can hide inside cells and form biofilms, making them difficult to eradicate, which is why longer treatment courses are sometimes necessary.
Additional Recommendations
- Consultation with an infectious disease specialist is recommended for the treatment of Bartonella infections, especially in cases of culture-negative endocarditis or in immunocompromised patients 1.
From the FDA Drug Label
Bartonellosis due to Bartonella bacilliformis. Doxycycline is indicated for the treatment of Bartonellosis caused by Bartonella bacilliformis 2.
- The treatment option is doxycycline (PO).
From the Research
Treatment Options for Bartonella
- The treatment for Bartonella infections varies depending on the severity and type of infection, as well as the patient's immune status 3.
- For patients with Bartonella lymphadenopathy, antibiotics do not significantly affect the cure rate 3, 4.
- Gentamicin and doxycycline are recommended for the treatment of Bartonella bacteraemia 3, 5, 4.
- The combination of gentamicin and doxycycline is also considered the best treatment regimen for endocarditis caused by Bartonella 3.
- Erythromycin is the first-line antibiotic therapy for the treatment of angioproliferative lesions, such as bacillary angiomatosis and peliosis hepatis 3.
- Rifampicin or streptomycin can be used to treat verruga peruana, a condition caused by Bartonella bacilliformis 3.
- Azithromycin or erythromycin, doxycycline, gentamicin, rifampin, and ciprofloxacin are generally effective in acute infection, but treatment of chronic infection remains problematic 6.
- The combination of azlocillin and azithromycin may be an effective treatment for Bartonellosis, especially in cases of chronic infection 6.
Antibiotic Resistance
- Resistance to antibiotics is a concern in the treatment of Bartonella infections, and the mechanism of resistance can vary depending on the antibiotic and the species of Bartonella 5.
- Ciprofloxacin-, rifampicin-, and erythromycin-resistant mutants have been obtained in vitro, and the molecular mechanisms of resistance have been characterized 5.
- Doxycycline and gentamicin may be the preferred regimen for the treatment of the acute and eruptive stages of Carrion's disease, but clinical trials are needed to support this finding 5.
Current Treatment Guidelines
- Current clinical practice for the treatment of bartonellosis relies mostly on expert opinion and antimicrobial susceptibility data, and randomized controlled trials are needed to compare different treatment options 4, 7.
- Treatment should be chosen individually, taking into account the severity and type of infection, as well as the patient's immune status 3, 7.