Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents

The information in the brief version is excerpted directly from the full-text guidelines. The brief version is a compilation of the tables and boxed recommendations.

Bartonellosis

Last Updated: May 7, 2013; Last Reviewed: March 13, 2017

Recommendations for Treating Bartonella Infections
Preferred Therapy
For Bacillary Angiomatosis, Peliosis Hepatis, Bacteremia, and Osteomyelitis:
  • Doxycycline 100 mg PO or IV q12h (AII), or
  • Erythromycin 500 mg PO or IV q6h (AII)
For Infections Involving the CNS:
  • Doxycycline 100 mg PO or IV q12h +/- rifampin 300 mg PO or IV q12h (AIII)
For Confirmed Bartonella Endocarditis:
  • (Doxycycline 100 mg IV q12h + gentamicin 1 mg/kg IV q8h) x 2 weeks, then continue with doxycycline 100 mg IV or PO q12h (BII), or
  • For patients with renal insufficiency: (doxycycline 100 mg IV q12h + rifampin 300 mg IV or PO q12h) x 2 weeks, then continue with doxycycline 100 mg IV or PO q12h (BII)
For Other Severe Infections
  • Doxycycline 100 mg PO or IV q12h + rifampin 300 mg PO or IV q12h (BIII), or
  • Erythromycin 500 mg PO or IV q6h + rifampin 300 mg PO or IV q12h (BIII)
Alternative Therapy for Bartonella Infections (Not for Endocarditis or CNS Infections):
  • Azithromycin 500 mg PO daily (BIII), or 
  • Clarithromycin 500 mg PO BID (BIII)
Duration of Therapy:
  • At least 3 months
Indication for Long-Term Suppressive Therapy 
If a relapse occurs after a ≥3 month course of primary treatment:
  • A macrolide or doxycycline as long as the CD4 count remains <200 cells/mm3 (AIII)
Indications for Discontinuing Long-Term Suppressive Therapy (CIII)
  • Received at least 3 to 4 months of treatment; and 
  • CD4 count >200 cells/mm3 for at least 6 months
  • Some specialists would only discontinue therapy if Bartonella titers have also decreased by four-fold 
Other Considerations
  • Rifampin is a potent hepatic enzyme inducer and may lead to significant interaction with many drugs; including ARV agents (see Table 5 for dosing recommendations)
Key to Abbreviations: ARV = antiretroviral; BID = twice daily; CD4 = CD4 T lymphocyte cell; CNS = central nervous system, IV = intravenously, PO = orally; q(n)h = every “n” hours

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