Table 4.

Main studies on treatment and management of cat scratch disease (CSD) lymphadenitis.

Authors (Year)	Type of Study	Study Population	Age Median Months (Range)	Therapy	Results
Margileth (1992) [87]	Retrospective study	268 patients with moderate–severe CSD	240 (6–864)	Group 1 (66 patients): no antibiotic Group 2 (113 patients): antibiotic no effective Group 3 (89 patients): antibiotic effective	4/18 different antimicrobials had demonstrable efficacy Antibiotic effectiveness: Rifampin: 13/15 (87%) Ciprofloxacin: 27/32 (84%) Gentamicin: 11/15 (73%) Trimethoprim and sulfamethoxazole: 26/45 (58%) Penicillins, cephalosporins, tetracycline, and erythromycin had minimal or no clinical efficacy
Bass (1998) [88]	RCT	29 children with cat scratch lymphadenopathy	210 (12–670)	15 received oral azithromycin: ≥45.5 kg: single dose of 500 mg on the 1st treatment day, followed by 250 mg daily for treatment days 2–5 <45.5 kg: 10 mg/kg the first day, followed by 5 mg/kg/d for the 2–5 day of treatment 14 received placebo	30 days after initiation of therapy assessment, significative reduction (≥80%) in affected lymph node volume: 7/14 azithromycin group vs. 1/15 placebo group (p = 0.026)
Garnier (2016) [85]	Retrospective study	51 patients with suppurated CSD’s lymphadenitis treated with oral azithromycin	Mean age 26.3 years 17/51 (33%) < 15 years	Group 1: 26 (51%) oral azithromycin without intranodal injection of gentamicin Group 2: 25 (49%) received intranodal injection of gentamicin	Combined treatment was related to a higher probability of cure without complication vs. treatment with oral azithromycin only (64% versus 31%, p = 0.01) Complication: Group 1: 18/26 (69%), of whom 5 required surgery Group 2: 9/25 (36%), of whom 4 required surgery
Lindeboom (2015) [58]	Prospective study	53 children with cervical lymphadenitis caused by B. henselae	59 (16–148)	The patients were not treated with antibiotics 11/51 (21%): repeated aspiration of pus was performed 40/51 (79%): wait-and-see-policy	Mean resolution time: 5 ± 3.1 months in intervention group vs. 8.2 ± 3.8 months in wait-and-see group (p = 0.01)
Shorbatli (2018) [89]	Retro-spective study	175 children with CSD lymphadenitis	Mean age 7.4 years	Group 1: 102/175 were treated with oral azithromycin (10 mg/kg/die with maximum of 500 mg orally for day 1 and 5 mg/kg with maximum of 250 mg once daily on days 2–5 as a suspension) Group 2: 18/175 were treated with oral TMP/SMX (trimethoprim component 8–20 mg/kg orally divided twice daily for 7–14 days as a suspension) Group 3: 10/175 received no antibiotic therapy Group 4: 45/175 received single or combined therapy with clindamycin, amoxicillin/clavulanate, doxycycline, cephalexin, ciprofloxacin, erythromycin, incision, and drainage or excision of lymph node	In Group 1, resolution or improvement was achieved in 51.4% (37/72) of patients without additional medical or surgical intervention 48.6% (35/72) not improved: 2 had no additional therapy 33 received a second course of azithromycin, TMP/SMX, erythromycin, amoxicillin/clavulanate, or rifampin with/without surgical intervention. Response to additional interventions was achieved in 78.7% (26/33) In Group 2, resolution or improvement was achieved in 61.5% (8/13) of patients without additional medical or surgical intervention No statistically significant difference in the effectiveness based on CSD resolution or improvement between azithromycin and TMP/SMX groups (p = 0.56) (OR 0.66; 95% CI of OR [0.15, 2.56])

CI—confidence interval; OR—odds ratio; TMP/SMX—trimethoprim/sulfamethoxazole.