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Background   Bartonella henselae  is a Gram-negative bacterium transmitted to humans by a scratch from cat in the presence of ectoparasites. Humans infected with  B. henselae  can result in various clinical diseases including local lymphadenopathy and more serious systemic disease such as persistent bacteremia and endocarditis. The current treatment of persistent  B. henselae  infections is not very effective and remains a challenge. To find more effective treatments for persistent and biofilm  Bartonella  infections, in this study, we evaluated a panel of drugs and drug combinations based on the current treatment and also promising hits identified from a recent drug screen against stationary phase and biofilm recovered cells of  B. henselae .    Results  We evaluated 14 antibiotics and 25 antibiotic combinations for activity against stationary phase  B. henselae  (all antibiotics were at 5 μg/ml) and found that ciprofloxacin, gentamicin, and nitrofurantoin were the most active agents, while clofazimine and miconazole had poor activity. Drug combinations azithromycin/ciprofloxacin, azithromycin/methylene blue, rifampin/ciprofloxacin, and rifampin/methylene blue could rapidly kill stationary phase  B. henselae  with no detectable CFU after 1-day exposure. Methylene blue and rifampin were the most active agents against the biofilm  B. henselae  after 6 days of drug exposure. Antibiotic combinations (azithromycin/ciprofloxacin, azithromycin/methylene blue, rifampin/ciprofloxacin, rifampin/methylene blue) completely eradicated the biofilm  B. henselae  after treatment for 6 days.    Conclusions  These findings may facilitate development of more effective treatment of persistent  Bartonella  infections in the future.

Effect of different drugs and drug combinations on killing stationary phase and biofilms recovered cells of Bartonella henselae in vitro