Bartonella Infection: Treatment and Drug Resistance

Silpak Biswas; Jean-Marc Rolain


Future Microbiol. 2010;5(11):1719-1731. 

In This Article


The available data on Bartonella species have expanded rapidly in recent years as this group of organisms has been found to be responsible for a growing spectrum of emerging and re-emerging diseases. A large number of domestic and nondomestic animals harbor persistent Bartonella infections. Bartonella infections in animals and in humans present unique treatment challenges due to their persistent nature and the frequent relapses observed, and the intraerythrocytic phase may provide a protective niche for the bacteria. The recommended antibiotics for the treatment of bartonellosis differ for each clinical situation. With the recent identification of Bartonella species as emerging infectious agents, clinicians and microbiologists are becoming aware of the need for more efficient and practical means of laboratory diagnosis. Bartonella species showed different susceptibility and resistance patterns for different antibiotics in vitro. The prompt laboratory confirmation of Bartonella infections could lead to effective antibiotic treatment in immunocompromised hosts or in cases involving systemic infections. In severe human bartonellosis, and in Bartonella endocarditis in particular, doxycycline for 6 weeks in combination with gentamicin for 2 weeks are recommended. Rifampin and fluoroquinolones should not be used alone for the treatement of bartonellosis as in vitro-resistant mutants against these antibiotics are easily obtained. Based on our current knowledge, antibiotic treatment for Bartonella should not be routinely recommended for healthy dogs and cats. Our knowledge of the characteristics of Bartonella species should be applied to develop more effective means of antibiotic treatment and the prevention of diseases caused by these unique organisms.