Treatment
10
Cat Scratch Disease and Bacillary Angiomatosis
Î Azithromycin is recommended for cat scratch disease (SR-M)
according to the following dosing protocol:
• Patients >45 kg, 500 mg on day 1 followed by 250 mg for 4 additional days
(SR-M).
• Patients <45 kg, 10 mg/kg on day 1 and 5 mg/kg for 4 more days (SR-M).
Î Erythromycin 500 mg qid or doxycycline 100 mg bid for 2 weeks to 2
months is recommended for treatment of bacillary angiomatosis (SR-M).
Erysipeloid
Î Penicillin 500 mg qid or amoxicillin 500 mg tid for 7-10 days is
recommended for treatment of erysipeloid (SR-H).
Glanders
Î Ceftazidime, gentamicin, imipenem, doxycycline or ciprofloxacin is
recommended based on in vitro susceptibility (SR-L).
Bubonic Plague
Î Bubonic plague should be diagnosed by Gram stain and culture
of aspirated material from a suppurative lymph node (SR-M).
Streptomycin 15 mg/kg IM q12h or doxycycline 100 mg bid PO is
recommended for treatment of bubonic plague (SR-L). Gentamicin
could be substituted for streptomycin (WR-L).
Tularemia
ÎSerologic tests are the preferred method of diagnosing tularemia (WR-L).
Î Streptomycin 15 mg/kg q12h IM or gentamicin 1.5 mg/kg q8h IV is
recommended for treatment of severe cases of tularemia (SR-L).
Î Tetracycline 500 mg qid or doxycycline 100 mg bid PO is
recommended for treatment of mild cases of tularemia (SR-L).
Î Notify the microbiology laboratory if tularemia is suspected (SR-H).
Immunocompromised Patients
Î In addition to infection, differential diagnosis of skin lesions should
include drug eruption, cutaneous infiltration with the underlying
malignancy, chemotherapy- or radiation-induced reactions, Sweet's
syndrome, erythema multiforme, leukocytoclastic vasculitis and graft-
versus-host disease among allogeneic transplant recipients (SR-H).
Î Differential diagnosis for infection of skin lesions should include
bacterial, fungal, viral and parasitic agents (SR-H).
