Cat Scratch Disease (cont.)
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Cat Scratch Disease Treatment
Treatment of CSD usually begins with symptomatic treatment of the pain and fever (if present) with acetaminophen or ibuprofen. Warm compresses to swollen lymph nodes can help reduce pain. Some doctors aspirate tender swollen lymph nodes with needles; incision and drainage of lymph nodes is not recommended because it does not speed recovery and may cause scars and fistulae (abnormal connections between organs) that continually drain and may develop secondary infections. Antibiotics are not used in the majority of patients. However, in patients with severe lymph node pain, azithromycin may lessen the pain but does not decrease the length of time that symptoms are present.
In contrast, most physicians advise antibiotic treatment in any immunocompromised patients. Bartonella henselae are usually resistant to several penicillin-based antibiotics like amoxicillin, but reports in the literature suggest that antibiotics such as trimethoprim-sulfamethoxazole, gentamicin, rifampin, ciprofloxacin, azithromycin, and others are effective. Antibiotics are suggested for immunosuppressed patients because the immune systems of these patients often are not able to limit growth of or kill bacteria (and other pathogens) as well as people with uncompromised immune systems. The antibiotics help immunocompromised patients reduce and eliminate these bacteria and thus reduce complications that may occur if the bacteria spread to other organ systems. There seems to be no consensus about which antibiotic is best; the choice of antibiotic is usually made by the treating physician with consideration of the patient's overall medical condition (e.g., age, renal function, allergies).
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