What Is the Treatment for Bacillary Angiomatosis?
Bacillary angiomatosis is a Bartonella bacterial infection managed with systemic antibiotic therapy. This page outlines the first-line treatment approach and the serological goals used to gauge response.
Treatment Approach
Management centres on an extended course of antibiotic therapy directed at the causative organism. Both primary and alternative antibiotic options exist, chosen based on clinical context and tolerability.
Clinical Goals
Treatment response is assessed serologically. The primary endpoint is at least a fourfold decrease in anti-Bartonella IFA IgG antibody titers, monitored on sequential endpoint titers every 6 to 8 weeks during treatment.
References
- Erythromycin and doxycycline have been used successfully to treat BA, peliosis hepatis, bacteremia, and osteomyelitis; either drug is considered first-line treatment for bartonellosis on the basis of reported experience in case series (AII).
- Therapy should be administered for at least 3 months (AII).
- Anecdotal and limited published case reports suggest that other macrolide antibiotics (such as azithromycin or clarithromycin) are effective in treating Bartonella infections in patients with HIV and may be better tolerated than erythromycin; either of these can be an alternative therapy for Bartonella infections (except for endocarditis or central nervous system [CNS] infections) (BIII).
- For patients with positive or increasing antibody titers, but with clinical improvement, treatment should continue until at least a fourfold decrease in the antibody titers is documented (CIII).