From the Guidelines
Azithromycin is the recommended antibiotic for cat scratch disease, with a dose of 500 mg on day 1, then 250 mg daily for 4 more days for patients weighing ≥45.5 kg. This recommendation is based on a double-blind placebo-controlled study that showed azithromycin to be effective in reducing lymph node size in patients with cat scratch disease 1.
Key Points to Consider
- Cat scratch disease is typically caused by Bartonella henselae and can lead to lymphadenopathy, which usually resolves within 1-6 months 1.
- In some cases, the disease can progress to extranodal disease, such as central nervous system or liver involvement, especially in immunocompromised patients 1.
- Diagnosis of cat scratch disease can be challenging due to the fastidious nature of the organism, but serological testing, PCR, and Warthin-Starry silver stain can aid in diagnosis 1.
- Treatment with azithromycin has shown promising results, with a significant reduction in lymph node size compared to placebo 1.
Management of Cat Scratch Disease
- For patients with signs of infection, such as increasing redness, swelling, warmth, pus, or fever, antibiotics like azithromycin should be considered 1.
- It is essential to clean the wound thoroughly with soap and water, apply an antiseptic, and cover with a sterile bandage to prevent further infection.
- Patients with weakened immune systems or those with scratches near joints or on the face should seek medical attention promptly if signs of infection develop.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Cat Scratch Disease Antibiotics
- The most effective antibiotics for cat scratch disease are rifampin, ciprofloxacin, gentamicin, trimethoprim and sulfamethoxazole, clarithromycin, and azithromycin 2
- Azithromycin has been shown to speed recovery in one small study 3
- Erythromycin and doxycycline are also effective in treating severe or persistent cases of cat scratch disease 4
- A study of 268 patients with cat scratch disease found that rifampin, ciprofloxacin, trimethoprim-sulfamethoxazole, and gentamicin were efficacious in treating the disease 5
Antibiotic Treatment Guidelines
- Most cases of cat scratch disease are self-limited and do not require antibiotic treatment 2, 3, 4
- Antibiotic therapy can be considered for patients with severe cat scratch disease 5
- Conservative, symptomatic treatment is recommended for the majority of patients with mild or moderate cat scratch disease 5