PROSPECTIVE RANDOMIZED DOUBLE-BLIND PLACEBO-CONTROLLED EVALUATION OF AZITHROMYCIN FOR TREATMENT OF CAT-SCRATCH DISEASE

Objective. To determine the efficacy of azithromycin in the treatment of patients with typical eat-scratch disease. Design. Prospective, ran domized, double blind, placebo-controlled clinical trial. Setting. Lar ge military medical center and its referring clinics. Patients. Active duty military members and their dependents with laboratory-confirmed, clinically typical cat-scratch disease. Intervention Study participan ts assigned by randomization to treatment with oral azithromycin or pl acebo for 5 days. Outcome measures. Lymph node volume was calculated u sing three dimensional ultrasonography at entry and at weekly interval s. The ultrasonographer was blinded to the treatment groups. Endpoint evaluations were predetermined as time in days to 80% resolution of th e initial total lymph node volume. Results. Demographic and clinical d ata showed that the azithromycin and placebo treatment groups were com parable at entry although the placebo group tended to be older. Eighty percent decrease of initial lymph node volume was documented in 7 of 14 azithromycin-treated patients compared with 1 of 15 placebo-treated controls during the first 30 days of observation (P = 0.026). After 3 0 days there was no significant difference in rate or degree of resolu tion between the two groups. Conclusions. Treatment of patients with t ypical cat-scratch disease with oral azithromycin for five days afford s significant clinical benefit as measured by total decrease in lymph node volume within the first month of treatment.