Antimicrobial therapy for treatment of South American bartonellosis*

Stage	Drug	Notes	Adult dose	Pediatric dose
Oroya fever (Carrion's disease)	Ciprofloxacin	Treatment of choice for uncomplicated Oroya fever in adults.	500 mg orally twice daily for 14 days	20 mg/kg orally in two divided doses for 14 days (max 1 g/day)^¶
	Chloramphenicol	Alternative treatment choice for treatment of Oroya fever; recurrence has been described. Administered in combination with ceftriaxone.	50 to 75 mg/kg/day (up to 3 g/day) orally or intravenously in four divided doses for 10 to 14 days Following defervescence, may be reduced to 25 mg/kg orally or intravenously in four divided doses	50 to 75 mg/kg/day (up to 2 g/day) orally or intravenously in four divided doses for 10 to 14 days^¶ Following defervescence, may be reduced to 25 mg/kg orally or intravenously in four divided doses
	Ceftriaxone	Administered in combination with chloramphenicol. Administered in combination with ciprofloxacin for treatment of severe disease.	1 g intravenously once daily for 10 to 14 days	50 to 75 mg/kg intravenously once daily for 10 to 14 days (maximum 1 g/day)
	Amoxicillin-clavulanic acid	Treatment of choice for uncomplicated Oroya fever in children and pregnant women.	1 g (based on amoxicillin) orally twice daily for 14 days	40 mg/kg (based on amoxicillin) orally in three divided doses for 14 days (maximum 2 g/day)
Verruga peruana (Peruvian wart)	Azithromycin	Treatment of choice in adults, children, and pregnant women.	500 mg orally once daily for 7 days	10 mg/kg orally once daily for 7 days (maximum 500 mg/day)
	Rifampin	Treatment failures have been reported; alternate treatment choice.	600 mg orally once daily for 14 to 21 days	10 mg/kg orally once daily for 14 to 21 days (maximum 600 mg/day)
	Ciprofloxacin	Alternate treatment choice.	500 mg orally twice daily for 7 to 10 days	20 mg/kg orally in two divided doses for 14 days (max 1 g/day)^Δ

Refer to Lexicomp drug monographs for further information.

* See text for discussion of approach to antibiotic selection.
¶ Chloramphenicol may cause bone marrow depression and aplastic anemia; dose adjustments are required for renal or hepatic impairment. Optimally, serum concentration should be monitored if chloramphenicol is employed. The risk of toxicity due to chloramphenicol may exceed that of ciprofloxacin.
Δ Ciprofloxacin is not a drug of first choice in children due to reported adverse events related to joints and/or surrounding tissues. In some pediatric studies, an increased risk of reversible adverse events involving joints or surrounding tissues, often due to reports of arthralgia, has been observed. However, no compelling published evidence supports the occurrence of sustained injury to developing bones or joints in children treated with available fluoroquinolone agents^[1]. The risks and benefits should be considered if a fluoroquinolone is prescribed in a child younger than 18 years of age.

Reference:

Bradley JS, Jackson MA, Committee on Infectious Diseases, American Academy of Pediatrics. The use of systemic and topical fluoroquinolones. Pediatrics 2011; 128:e1034.

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Antimicrobial therapy for treatment of South American bartonellosis*