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Treatment of cat scratch disease

David H Spach, MD
Sheldon L Kaplan, MD
Section Editors
Stephen B Calderwood, MD
Morven S Edwards, MD
Deputy Editor
Jennifer Mitty, MD, MPH


Cat scratch disease (CSD) is an infectious disease characterized by self-limited regional lymphadenopathy. The manifestations of CSD, however, can include visceral organ, neurologic, and ocular involvement [1,2]. Bartonella henselae is the etiologic agent in most cases of CSD.

The treatment of CSD will be reviewed here. The microbiology, epidemiology, and clinical features of CSD, Bartonella endocarditis, and other Bartonella infections are discussed separately. (See "Microbiology, epidemiology, clinical manifestations, and diagnosis of cat scratch disease" and "Endocarditis caused by Bartonella" and "Epidemiology and clinical manifestations of Bartonella infections in HIV-infected patients" and "Clinical features, diagnosis, and treatment of Bartonella quintana infections" and "South American bartonellosis: Oroya fever and verruga peruana".)


Most patients with typical cat scratch disease (CSD) have gradual resolution of symptoms, even without specific antibiotic therapy [3]. In 5 to 14 percent of individuals, the organisms disseminate and infect the liver, spleen, eye, or central nervous system [4,5]. Patients with disseminated disease can have life-threatening complications.

In vitro susceptibility testing often does not correlate with a clinical response and should not be considered in the choice of antibiotics [3]. The literature on the use of antibiotics in CSD primarily derives from case reports and small series. There is one prospective, randomized trial [6].

Lymphadenitis studies

A randomized prospective placebo-controlled trial of 29 immunocompetent patients (including children and adults) with typical cat scratch disease examined the effectiveness of a five-day course of azithromycin (10 mg/kg on day one and 5 mg/kg on the subsequent four days for patients weighing less than 45.5 kg and 500 mg on day 1, followed by 250 mg on the next four days for those weighing at least 45.5 kg) [6]. Seven of 14 patients who received azithromycin had an 80 percent or more decrease in lymph node volume during a 30-day follow-up period compared with only one of seven placebo recipients. This trial provides the most convincing data in favor of antibiotic treatment.


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Literature review current through: Sep 2016. | This topic last updated: Apr 1, 2016.
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