What is the first-line antibiotic therapy for cat-scratch disease?

• A. Azithromycin
• B. Doxycycline
• C. Amoxicillin
• D. Ceftriaxone

Answer: (A)

Cat-scratch disease is caused by Bartonella henselae and often presents as regional lymphadenopathy after a scratch or bite. Azithromycin is the best first-line antibiotic because it has good activity against Bartonella and penetrates intracellularly, helping to shorten the illness in otherwise healthy individuals. A typical approach uses a short course of azithromycin (often about 5 days), which is convenient and well tolerated.

Doxycycline can be effective, particularly in adults, but it isn’t used as the initial choice in children due to concerns about teeth and bone effects. Amoxicillin lacks reliable activity against Bartonella, so it isn’t appropriate as first-line therapy. Ceftriaxone is reserved for more severe, disseminated, or immunocompromised cases, not the typical mild, localized disease.