What is the role of azithromycin in the treatment of cat scratch disease (CSD)?

Updated: Feb 16, 2021
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

A prospective, randomized, double-blind, placebo-controlled study by Bass et al showed that azithromycin administered for 5 days decreased lymph node volume as measured by ultrasonography within the first month of treatment. No other differences in clinical outcome were noted. [62] Musso et al [64] found that aminoglycosides were bactericidal and Ives et al [65] showed that clarithromycin and azithromycin were efficacious in CSD. (See Table 3, below.)

Table 3. Response to Medications (Open Table in a new window)

Ciprofloxacin

500 PO bid

Case Report

5 adults

"Dramatic improvement" in a few days; defined as resolution of symptoms (ie, malaise and pain)

Holley [66]

Gentamicin

5 mg/kg/d IV/IM

Case Report

3 febrile children; 2 with hepatitis, 1 with painful regional lymphadenopathy

Resolution of fever and systemic symptoms in 1-2 days

Bogue et al [67]

TMP-SMZ

6-8 mg TMP/kg/d PO

Uncontrolled retrospective study

60 patients with prolonged fever and systemic symptoms

58% effective, 7-day course (see above)

Margileth [46]

Rifampin 10-20 mg/kg/d PO/IV

Uncontrolled retrospective study

60 patients with prolonged fever and systemic symptoms

87% effective, 7- to 14-day course (see above)

Margileth [63]

Azithromycin

500 mg PO qd for 1 day, then 250 mg PO qd for 4 days

Prospective placebo-controlled, double-blind study

29 patients

80% of lymph node volume (as measured by ultrasonography) resolved in 30 days in 7 of 15 patients on azithromycin vs 1 of 15 control patients

Bass et al [62]


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