Relapsing fever medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maliha Shakil, M.D. [2] Roghayeh Marandi
Overview
Antimicrobial therapy for relapsing fever in adults depends on the vector (Tick-borne vs. Louse-borne) and includes either Doxycycline, Erythromycin, or Tetracyclines. Intravenous Ceftriaxone is added if either meningitis or encephalitis is present.
Medical Therapy
Antimicrobial Medications
- Erythromycin, Tetracyclines, Chloramphenicol, or Penicillins have all been shown to be effective for treating tick-borne relapsing fever TBRF. Although the duration of therapy has not been well studied for TBRF, the current recommendation is seven days of antibiotic therapy. In contrast, louse-borne relapsing fever caused by B. recurrentis can be treated with a single dose of antibiotics.
- For young children and pregnant women either Erythromycin and/or Penicillin are recommended for the treatment of TBRF.
Antimicrobial regimen
Tick-Borne Relapsing Fever
- Preferred regimen: Doxycycline 100 mg PO bid for 5-10 days[1]
- Alternative regimen: Erythromycin 500 mg PO qid for 5-10 days
- Note: If meningitis/encephalitis present, use Ceftriaxone 2 g IV q12h for 14 days
Louse-Borne Relapsing Fever
- Preferred regimen: Tetracycline 500 mg PO single dose
- Alternative regimen: Erythromycin 500 mg PO single dose
Additional aspects of management
When initiating antibiotic therapy, a patient should be watched closely for a Jarisch-Herxheimer reaction for the first 4 hours after the antibiotic is given. The reaction may be difficult to distinguish from a febrile crisis, with rigors and decreased blood pressure. Cooling blankets and appropriate use of antipyretic agents may be indicated and may be lessened by giving acetaminophen 650 mg orally 2 hours before and 2 hours after the first dose of antibiotic therapy. This reaction tends to be more severe in patients with louse-borne relapsing fever treated with penicillin.
References
- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.