Bacterial Infections

  • Author: Harjot K. Singh, MD (More Info)
  • Editors in Chief: Joseph J. Eron, Jr., MD; Daniel R. Kuritzkes, MD
  • Last Reviewed: 8/31/21 (What's New)

Supporting Assets

Table 1 | Table 2 | Table 3 | Table 4 | Table 5 | Table 6

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

Duration: ≥ 3 mos

Duration: ≥ 3 mos

CNS infections and severe infections

Duration: ≥ 3 mos

 

Confirmed Bartonella endocarditis*

Duration: ≥ 3 mos

Other severe infections (multifocal disease or with clinical decompensation)

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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