TABLE 6.

Guidelines and recommendations for the treatment of infections caused by Bartonella speciesa

DiseaseRegimen fora:Strength of recommendationReference(s)
AdultsChildren
Typical CSDNo recommendationNo recommendation56
For patients with extensive lymphadenopathy, consider azithromycin at 500 mg p.o. on the first day and 250 mg p.o. on days 2 to 5 as a single daily doseFor patients with extensive lymphadenopathy, consider azithromycin at 10 mg/kg p.o. on day 1 and 5 mg/kg p.o. on days 2 to 5 as a single daily doseBI8, 84
RetinitisDoxycycline at 100 mg p.o. BID for 4-6 wk and rifampin at 300 mg p.o. BID for 4-6 wkUnknownAII56, 84
Trench fever or chronic bacteremia with B. quintanaDoxycycline at 200 mg p.o. QD for 4 wkUnknown36
and gentamicin 3 mg/kg i.v. QD for 2 wkAI
BAbErythromycin at 500 mg p.o. QID for 3 moErythromycin ethylsuccinate p.o. at a total of 40 mg/kg/day in four divided doses (maximum total daily dose, 2 g/day) for 3 monthsAII58
Or doxycycline at 100 mg p.o. BID for 3 moAII58
PHbErythromycin at 500 mg p.o. QID for 4 moErythromycin ethylsuccinate p.o. at 40 mg/kg total/day in four divided doses (maximum total daily dose, 2 g/day) for 4 moAII58
Or doxycycline at 100 mg p.o. BID for 4 moAII58
EndocarditisSuspected Bartonella, culture negative:
    Gentamicin at 3 mg/kg/day i.v. for 14 days and ceftriaxone at 2 g i.v. or i.m. QD for 6 wk with or without doxycycline at 100 mg p.o. or i.v. BID for 6 wkUnknownAII BII      BII83 83      83
EndocarditisDocumented Bartonella, culture positive:
    Doxycycline at 100 mg p.o. BID for 6 wk andBII83
        gentamicin at 3 mg/kg/day i.v. for 14 dayscBII83
Carrion's disease
    Oroya feverChloramphenicol at 500 mg p.o. or i.v. QID for 14 days and another antibiotic (a beta-lactam is preferred)Chloramphenicol at 50-75 mg/kg/day p.o. or i.v. divided into four doses for 14 days and another antibiotic (a beta-lactam is preferred)AII67
Or ciprofloxacin at 500 mg p.o. BID for 10 daysOr ciprofloxacin in children 7-12 years 250 mg p.o. BID for 10dBIIId
    Verruga peruanaRifampin at 10 mg/kg/day p.o. for 14 daysRifampin at 10 mg/kg/day p.o. for 14 days (maximum total daily dose of 600 mg/day)AII67
Or streptomycin at 15-20 mg/kg/day i.m. for 10 daysAII67
  • a Abbreviations: BID, twice a day; QD, once a day; QID, four times a day.

  • b Longer treatment for HIV-infected and other immunocompromised patients (AII) (56).

  • c If gentamicin cannot be given, replace it with rifampin at 300 mg p.o. twice daily.

  • d Maguina, unpublished.