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PubMed This is a summary of 16 peer-reviewed journal articles Updated
Pediatrics

Treatment Options & Care Team

At a Glance

Most cases of cat-scratch disease resolve on their own with supportive care and watchful waiting. For severe infections that spread to the eyes, liver, or brain, doctors typically prescribe a prolonged course of combination antibiotics and may involve an infectious disease specialist.

Managing Cat-scratch disease (CSD) is a balance between allowing the body’s immune system to do its job and stepping in with medical support when the infection becomes more complex. Because the infection is self-limiting in most healthy people, the “standard of care” often involves monitoring and supportive treatment rather than aggressive intervention [1][2].

Typical CSD: The “Watchful Waiting” Approach

For a healthy child or adult with a single swollen lymph node and no other severe symptoms, the primary goal is comfort.

  • Supportive Care: This includes rest, hydration, and over-the-counter pain relievers (or warm compresses) for tenderness or mild fever.
  • Antibiotics: Doctors may prescribe azithromycin (an antibiotic) to help the lymph nodes shrink more quickly [1][3]. However, research shows that for localized disease, the final health outcome is often the same whether or not antibiotics are used [1]. Note that azithromycin can sometimes cause minor side effects like upset stomach.
  • Alternative Options: If a patient is allergic to or cannot take azithromycin, other options like trimethoprim-sulfamethoxazole (TMP/SMX) may be used [4].

Atypical & Systemic CSD: Targeted Therapy

When the bacteria spread to the eyes, liver, spleen, or brain, the treatment plan becomes more intensive [2][5].

  • Combination Therapy: For severe or systemic disease, doctors often use two antibiotics together, such as doxycycline and rifampin [6][7]. These treatments are often prolonged, lasting several weeks or even months [8][9].
  • Pediatric Caution: Prolonged courses of doxycycline are typically carefully considered by pediatricians for children under 8 years old due to a risk of permanent tooth discoloration; your doctor will weigh this risk or discuss alternatives if needed [10]. Additionally, doxycycline can cause severe sun sensitivity.
  • Corticosteroids: In cases of severe eye inflammation (neuroretinitis), doctors may add corticosteroids (like prednisone) to the antibiotic regimen to reduce swelling, but only after an infectious cause has been confirmed [11][12].

Building Your Care Team

Depending on the symptoms, your care team may include several specialists.

  • Pediatrician or Primary Care Physician (PCP): The “home base” for managing localized CSD and coordinating care.
  • Infectious Disease (ID) Specialist: Should be involved if the infection is systemic, affecting internal organs, or if the patient is immunocompromised [13][10].
  • Ophthalmologist: Essential if there are any vision changes, eye redness, or suspected neuroretinitis [14][15].

Specialist Vetting Checklist

When meeting with a specialist or pediatrician, consider asking these questions to ensure a collaborative approach:

  1. Thresholds: “If my case becomes complex, at what point would you bring in an Infectious Disease specialist?”
  2. Coordination: “How will you coordinate the antibiotic plan with my other doctors to avoid drug interactions?”
  3. Monitoring: “What specific markers (blood tests or imaging) will you use to decide when the infection is fully cleared?”
  4. Urgency: “If we see a sudden change in symptoms, what is the protocol for reaching your team after hours?”

Because there is no “one-size-fits-all” treatment for complicated Bartonella infections, an individualized plan created by an experienced team is the best path forward [10][16].

Common questions in this guide

Do I always need antibiotics for cat-scratch disease?
For most healthy people with mild cat-scratch disease, antibiotics are not strictly necessary as the infection usually clears on its own. Your doctor may prescribe an antibiotic like azithromycin to help swollen lymph nodes shrink faster, though overall outcomes are often similar without medication.
What does the watchful waiting approach involve?
Watchful waiting involves letting your body's immune system naturally clear the infection while you manage the symptoms. This supportive care typically includes getting plenty of rest, staying hydrated, and using warm compresses or over-the-counter pain relievers for swollen, tender lymph nodes.
How is severe or systemic cat-scratch disease treated?
If the infection spreads to organs like the eyes, liver, spleen, or brain, treatment becomes more intensive. Doctors usually prescribe a combination of two antibiotics, such as doxycycline and rifampin, which may need to be taken for several weeks or months.
What kind of doctor treats cat-scratch disease?
A primary care physician or pediatrician typically manages standard cases. However, if the infection spreads to internal organs, affects your vision, or if you have a weakened immune system, your care team should expand to include an infectious disease specialist or an ophthalmologist.
What are the side effects of doxycycline for cat-scratch disease?
Doxycycline can cause severe sun sensitivity, making it easier to sunburn. In children under 8 years old, prolonged use of doxycycline is carefully evaluated by pediatricians because it carries a risk of permanent tooth discoloration.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.If we choose to wait and monitor without antibiotics, what specific changes in symptoms would trigger a need to start medication?
  2. 2.Are there any side effects of the antibiotics (like sun sensitivity or stomach upset) that we should be especially watchful for?
  3. 3.If my case becomes complex, at what point would you bring in an Infectious Disease specialist?
  4. 4.If we are using corticosteroids for eye inflammation, how will you ensure the underlying infection is fully controlled first?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (16)
  1. 1

    Cat-scratch disease: a wide spectrum of clinical pictures.

    Mazur-Melewska K, Mania A, Kemnitz P, et al.

    Postepy dermatologii i alergologii 2015; (32(3)):216-20 doi:10.5114/pdia.2014.44014.

    PMID: 26161064
  2. 2

    [Bartonella henselae with atypical infection and neuroretinitis in a pediatric unit: report of three cases].

    Pérez R, Fischman A, Poblete MJ, et al.

    Revista chilena de infectologia : organo oficial de la Sociedad Chilena de Infectologia 2020; (37(4)):463-469 doi:10.4067/S0716-10182020000400463.

    PMID: 33399668
  3. 3

    Clinical Presentation of Cat Scratch Disease in Pediatric Patients-A Single-Center Study.

    Öcal-Demir S, Kahraman K, Bozbeyoğlu G, Esen F

    Turkish archives of pediatrics 2024; (59(6)):574-579 doi:10.5152/TurkArchPediatr.2024.24032.

    PMID: 39540783
  4. 4

    Effectiveness of antibiotic therapy in pediatric patients with cat scratch disease.

    Shorbatli LA, Koranyi KI, Nahata MC

    International journal of clinical pharmacy 2018; (40(6)):1458-1461 doi:10.1007/s11096-018-0746-1.

    PMID: 30446895
  5. 5

    [Bone involvement in cat scratch disease].

    Razafindrazaka H, Redl S, Aouchiche F, et al.

    La Revue de medecine interne 2021; (42(12)):875-880 doi:10.1016/j.revmed.2021.06.010.

    PMID: 34215457
  6. 6

    Thoracic osteomyelitis and epidural abscess formation due to cat scratch disease: case report.

    Dornbos D, Morin J, Watson JR, Pindrik J

    Journal of neurosurgery. Pediatrics 2016; (25(6)):713-716 doi:10.3171/2016.7.PEDS1677.

    PMID: 27662446
  7. 7

    Prolonged course of hepatic granulomatous disease due to Bartonella henselae infection.

    De Keukeleire S, Geldof J, De Clerck F, et al.

    Acta gastro-enterologica Belgica 2016; (79(4)):497-499.

    PMID: 28209111
  8. 8

    Hepatosplenic Bartonellosis in an Immunocompetent Teenager: An Atypical Presentation of Cat-Scratch Disease.

    Sharma R, Arshad AM, Sardar S, Zafar A

    Cureus 2021; (13(2)):e13219 doi:10.7759/cureus.13219.

    PMID: 33717753
  9. 9

    Challenges of the treatment of pediatric hepatosplenic bartonellosis: case report and literature review.

    Kanık-Yüksek S, Gülhan B, Hürmüzlü S, et al.

    Journal of infection in developing countries 2022; (16(4)):712-716 doi:10.3855/jidc.15042.

    PMID: 35544635
  10. 10

    Can Lymphadenopathy Guide the Diagnosis of Hepatosplenic Bartonella Infection in Pediatric Renal Transplant Recipients? What Is the Optimal Treatment and Follow-Up Duration?

    Alataş ŞÖ, Erbaş İC, Güzin AÇ, et al.

    Pediatric transplantation 2025; (29(5)):e70113 doi:10.1111/petr.70113.

    PMID: 40495288
  11. 11

    Clinical Profile and Visual Outcome of Ocular Bartonellosis in Malaysia.

    Tan CL, Fhun LC, Tai EL, et al.

    Journal of tropical medicine 2017; (2017()):7946123 doi:10.1155/2017/7946123.

    PMID: 28265290
  12. 12

    Cat-scratch disease: ocular manifestations and treatment outcome.

    Habot-Wilner Z, Trivizki O, Goldstein M, et al.

    Acta ophthalmologica 2018; (96(4)):e524-e532 doi:10.1111/aos.13684.

    PMID: 29504674
  13. 13

    Bartonella infections diagnosed in the French reference center, 2014-2019, and focus on infections in the immunocompromised.

    Luciani L, El Baroudi Y, Prudent E, et al.

    European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology 2021; (40(11)):2407-2410 doi:10.1007/s10096-021-04244-z.

    PMID: 33846874
  14. 14

    A Case of Cat Scratch Disease with Neuroretinitis in a 16-Month-Old Boy.

    Nakata D, Kakehi S, Okada H, et al.

    Case reports in ophthalmological medicine 2022; (2022()):2841683 doi:10.1155/2022/2841683.

    PMID: 36277508
  15. 15

    Posterior Segment Manifestations of Cat-scratch Disease: A Mini-review of the Clinical and Multi-modal Imaging Features.

    Karti O, Ataş F, Saatci AO

    Neuro-ophthalmology (Aeolus Press) 2021; (45(6)):361-371 doi:10.1080/01658107.2021.1939393.

    PMID: 34720266
  16. 16

    Bartonella henselae infection in the pediatric solid organ transplant recipient.

    Lopez SMC, Davis A, Zinn M, et al.

    Pediatric transplantation 2021; (25(5)):e13823 doi:10.1111/petr.13823.

    PMID: 32841466

This page provides educational information on treatment approaches for cat-scratch disease. Always consult your pediatrician, primary care physician, or infectious disease specialist to determine the safest and most effective care plan for you or your child.

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