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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: Nov 2017. | This topic last updated: Apr 01, 2016.
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  1. Bass JW, Vincent JM, Person DA. The expanding spectrum of Bartonella infections: II. Cat-scratch disease. Pediatr Infect Dis J 1997; 16:163.
  2. Spach DH, Koehler JE. Bartonella-associated infections. Infect Dis Clin North Am 1998; 12:137.
  3. Rolain JM, Brouqui P, Koehler JE, et al. Recommendations for treatment of human infections caused by Bartonella species. Antimicrob Agents Chemother 2004; 48:1921.
  4. Carithers HA. Cat-scratch disease. An overview based on a study of 1,200 patients. Am J Dis Child 1985; 139:1124.
  5. Margileth AM. Cat scratch disease. Adv Pediatr Infect Dis 1993; 8:1.
  6. Bass JW, Freitas BC, Freitas AD, et al. Prospective randomized double blind placebo-controlled evaluation of azithromycin for treatment of cat-scratch disease. Pediatr Infect Dis J 1998; 17:447.
  7. Margileth AM. Antibiotic therapy for cat-scratch disease: clinical study of therapeutic outcome in 268 patients and a review of the literature. Pediatr Infect Dis J 1992; 11:474.
  8. Holley HP Jr. Successful treatment of cat-scratch disease with ciprofloxacin. JAMA 1991; 265:1563.
  9. Chia JK, Nakata MM, Lami JL, et al. Azithromycin for the treatment of cat-scratch disease. Clin Infect Dis 1998; 26:193.
  10. Bogue CW, Wise JD, Gray GF, Edwards KM. Antibiotic therapy for cat-scratch disease? JAMA 1989; 262:813.
  11. Arisoy ES, Correa AG, Wagner ML, Kaplan SL. Hepatosplenic cat-scratch disease in children: selected clinical features and treatment. Clin Infect Dis 1999; 28:778.
  12. Reed JB, Scales DK, Wong MT, et al. Bartonella henselae neuroretinitis in cat scratch disease. Diagnosis, management, and sequelae. Ophthalmology 1998; 105:459.
  13. Rosen BS, Barry CJ, Nicoll AM, Constable IJ. Conservative management of documented neuroretinitis in cat scratch disease associated with Bartonella henselae infection. Aust N Z J Ophthalmol 1999; 27:153.
  14. Koehler JE, Quinn FD, Berger TG, et al. Isolation of Rochalimaea species from cutaneous and osseous lesions of bacillary angiomatosis. N Engl J Med 1992; 327:1625.
  15. Koehler JE, Duncan LM. Case records of the Massachusetts General Hospital. Case 30-2005. A 56-year-old man with fever and axillary lymphadenopathy. N Engl J Med 2005; 353:1387.
  16. King KY, Hicks MJ, Mazziotti MV, et al. Persistent cat scratch disease requiring surgical excision in a patient with MPGN. Pediatrics 2015; 135:e1514.
  17. Tunkel AR, Glaser CA, Bloch KC, et al. The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2008; 47:303.
  18. Florin TA, Zaoutis TE, Zaoutis LB. Beyond cat scratch disease: widening spectrum of Bartonella henselae infection. Pediatrics 2008; 121:e1413.
  19. ECKHARDT WF Jr, LEVINE AI. Corticosteroid therapy of cat-scratch disease. Results of treatment in three cases with rapid resolution of painful lymphadenopathy; Tietze's syndrome and bilateral cervical adenitis as new complications. Arch Intern Med 1962; 109:463.
  20. Lerdluedeeporn P, Krogstad P, Roberts RL, Stiehm ER. Oral corticosteroids in cat-scratch disease. Clin Pediatr (Phila) 2003; 42:71.
  21. Bryant K, Marshall GS. Hepatosplenic cat scratch disease treated with corticosteroids. Arch Dis Child 2003; 88:345.