Rocky Mountain spotted fever medical therapy: Difference between revisions

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Latest revision as of 18:39, 18 September 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]

Overview

The mainstay of therapy for rocky mountain spotted fever is doxycycline. Pharmacologic therapy for Rocky Mountain spotted fever (RMSF) includes either Doxycycline or Chloramphenicol.

Medical Therapy

Doxycycline is the mainstay of therapy for Rocky Mountain spotted fever. Use of antibiotics other than doxycycline is associated with a higher risk of fatal outcome.
Treatment is most effective at preventing death if doxycycline is started in the first 5 days of symptoms.
Empirical antibiotic therapy should be initiated immediately when there is a suspicion of Rocky Mountain spotted fever on the basis of clinical and epidemiologic findings.
Treatment should not be delayed until laboratory confirmation is obtained.
If the patient is treated within the first 4-5 days of the disease, fever generally subsides within 24-72 hours.
Failure to respond to doxycycline argues against a diagnosis of RMSF.
Severely ill patients may require longer periods before their fever resolves, especially if they have experienced damage to multiple organ systems.
Preventive therapy in non-ill patients who have had recent tick bites is not recommended and may, in fact, only delay the onset of disease. ^[1]

Antimicrobial regimens

Rocky Mountain spotted fever^[1]

1. Adults

Preferred regimen: Doxycycline 100 mg PO q12h for 7-14 days
Note: Treatment with antibiotic agents other than doxycycline is associated with worse outcomes.

2. Children under 45kg

Preferred regimen: Doxycycline 2.2 mg/kg PO q12h for 7-14 days

References

↑ ^1.0 ^1.1 Rocky Mountain Spotted Fever Symptoms. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/rmsf/symptoms/index.html Accessed on December 30, 2015

[RMSF_Treatment_CDC”-1] 1.0 ^1.1 Rocky Mountain Spotted Fever Symptoms. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/rmsf/symptoms/index.html Accessed on December 30, 2015

[1]

@@ Line 1: / Line 1: @@
 {{Rocky Mountain spotted fever}}
-{{CMG}}
+{{CMG}}{{AE}}{{SR}}
+__NOTOC__
 ==Overview==
+The mainstay of therapy for rocky mountain spotted fever is doxycycline.  Pharmacologic therapy for Rocky Mountain spotted fever (RMSF) includes either [[Doxycycline]] or [[Chloramphenicol]].
+==Medical Therapy==
+*Doxycycline is the mainstay of therapy for Rocky Mountain spotted fever. Use of antibiotics other than doxycycline is associated with a higher risk of fatal outcome.
+*Treatment is most effective at preventing death if doxycycline is started in the first 5 days of symptoms.
+*Empirical antibiotic therapy should be initiated immediately when there is a suspicion of Rocky Mountain spotted fever on the basis of clinical and epidemiologic findings.
+*Treatment should not be delayed until laboratory confirmation is obtained.
+*If the patient is treated within the first 4-5 days of the disease, fever generally subsides within 24-72 hours.
+*Failure to respond to doxycycline argues against a diagnosis of RMSF.
+*Severely ill patients may require longer periods before their fever resolves, especially if they have experienced damage to multiple organ systems.
+*Preventive therapy in non-ill patients who have had recent tick bites is not recommended and may, in fact, only delay the onset of disease. <ref name="RMSF Treatment CDC”">Rocky Mountain Spotted Fever Symptoms. Centers for Disease Control and Prevention (2015).  http://www.cdc.gov/rmsf/symptoms/index.html Accessed on December 30, 2015</ref>
-==Treatment==
+===Antimicrobial regimens===
-Appropriate antibiotic treatment should be initiated immediately when there is a suspicion of Rocky Mountain spotted fever on the basis of clinical and epidemiologic findings. Treatment should not be delayed until laboratory confirmation is obtained.
+*'''Rocky Mountain spotted fever'''<ref name="RMSF Treatment CDC”">Rocky Mountain Spotted Fever Symptoms. Centers for Disease Control and Prevention (2015).  http://www.cdc.gov/rmsf/symptoms/index.html Accessed on December 30, 2015</ref>
+:*'''1. Adults'''
-If the patient is treated within the first 4-5 days of the disease, fever generally subsides within 24-72 hours after treatment with an appropriate antibiotic (usually in the tetracycline class). In fact, failure to respond to a tetracycline antibiotic argues against a diagnosis of RMSF. Severely ill patients may require longer periods before their fever resolves, especially if they have experienced damage to multiple organ systems. Preventive therapy in non-ill patients who have had recent tick bites is not recommended and may, in fact, only delay the onset of disease.
+::*Preferred regimen: [[Doxycycline]] 100 mg PO q12h for 7-14 days
-<gallery>
+::*Note: Treatment with antibiotic agents other than doxycycline is associated with worse outcomes.
-Image:Removal.jpg|Removal of an embedded tick using fine-tipped tweezers
+:*'''2. Children under 45kg'''
-Image:Tick removal process.jpg|Tick removal process
+::*Preferred regimen: [[Doxycycline]] 2.2 mg/kg PO q12h for 7-14 days
-</gallery>
-===What is the best way to remove a tick?===
-#Use fine-tipped tweezers or notched tick extractor, and protect your fingers with a tissue, paper towel, or latex gloves. Persons should avoid removing ticks with bare hands.
-#Grasp the tick as close to the skin surface as possible and pull upward with steady, even pressure. Do not twist or jerk the tick; this may cause the mouthparts to break off and remain in the skin. (If this happens, remove mouthparts with tweezers. Consult your health care provider if illness occurs.)
-#After removing the tick, thoroughly disinfect the bite site and wash your hands with soap and water.
-#Do not squeeze, crush, or puncture the body of the tick because its fluids may contain infectious organisms. Skin accidentally exposed to tick fluids can be disinfected with iodine scrub, rubbing alcohol, or water containing detergents.
-#Save the tick for identification in case you become ill. This may help your doctor to make an accurate diagnosis. Place the tick in a sealable plastic bag and put it in your freezer. Write the date of the bite on a piece of paper with a pencil and place it in the bag.
-===Do folklore remedies work?===
-No. Folklore remedies, such as the use of petroleum jelly or hot matches, do little to encourage a tick to detach from skin. In fact, they may make matters worse by irritating the tick and stimulating it to release additional saliva or regurgitate gut contents, increasing the chances of transmitting the pathogen. These methods of tick removal should be avoided.
-===Antimicrobial regimen===
-:* Preferred regimen: [[Doxycycline]] 100 mg q12h
-:* Alternative regimen: [[Chloramphenicol]] especially in pregnant women, but needs close monitoring.
-:* Pediatric regimen: [[Doxycycline]] 2.2 mg/kg PO bid (under 45 kg (100 lbs))
-:* Note: Patients should be treated for at least 3 days after the fever subsides and until there is evidence of clinical improvement; Standard duration of treatment is 7-14 days.
 ==References==
 {{Reflist|2}}
+[[Category:Bacterial diseases]]
+[[Category:Rickettsiales]]
+[[Category:Zoonoses]]
-[[Category:Infectious Disease Project]]
+[[Category:Dermatology]]