Supporting Assets

Table 1. Treatment of Bartonella Infection in Patients With HIV

Indication	First-Choice Treatment	Alternative Options
Bacillary angiomatosis, cat scratch disease, peliosis hepatitis, bacteremia, and osteomyelitis	Doxycycline 100 mg PO or IV Q12 hrs or Erythromycin 500 mg PO or IV Q6 hrs Duration: ≥ 3 mos	Azithromycin 500 mg PO Q24 hrs or Clarithromycin 500 mg PO Q12 hrs Duration: ≥ 3 mos
CNS infections and severe infections	Doxycycline 100 mg PO or IV Q12 hrs ± rifampin* 300 mg PO or IV Q12 hrs Duration: ≥ 3 mos
Confirmed Bartonella endocarditis*	Doxycycline 100 mg IV Q12 hrs + rifampin* 300 mg IV or PO Q12 hrs for 6 wks, followed by doxycycline (alone) 100 mg IV or PO Q12 hrs or Doxycycline 100 mg IV Q12 hrs + gentamicin 1 mg/kg IV Q8 hrs for 2 wks, followed by doxycycline (alone) 100 mg IV or PO Q12 hrs^† Duration: ≥ 3 mos
Other severe infections (multifocal disease or with clinical decompensation)	Doxycycline 100 mg PO or IV Q12 hrs + rifampin* 300 mg PO or IV Q12 hrs or Erythromycin 500 mg PO or IV Q6 hrs + rifampin* 300 mg PO or IV Q12 hrs Duration: ≥ 3 mos
Long-term suppression for patients with relapse or reinfection after treatment completion	Macrolide or doxycycline as long as CD4+ cell count remains < 200 cells/mm³ May end when patient receives ≥ 3-4 mos of treatment CD4+ cell count > 200 cells/mm³ for ≥ 6 mos Some specialists require Bartonella titer to decrease by 4-fold

CNS, central nervous system; IV, intravenous; PO, orally; QD, daily;
*Rifampin is a potent hepatic enzyme inducer and may lead to significant interaction with many drugs, including antiretroviral agents, which may require dose adjustments. Consult Table 5 in the “Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents.”^{[CDC OI]}
^†This regimen seen as second line because of potential gentamicin nephrotoxicity as glomerulonephritis frequently complicates Bartonella endocarditis.

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