Relapsing fever medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Relapsing fever}} | {{Relapsing fever}} | ||
{{CMG}} | {{CMG}} {{AE}} {{Maliha}} [[Roghayeh Marandi]] | ||
==Overview== | ==Overview== | ||
[[Antimicrobial]] therapy for [[relapsing fever]] in adults depends on the [[vector]] ([[Tick-borne relapsing fever|Tick-borne]] vs. [[Louse-borne relapsing fever|Louse-borne]]) and includes either [[Doxycycline]], [[Erythromycin]], or [[Tetracyclines]]. Intravenous [[Ceftriaxone]] is added if either [[meningitis]] or [[encephalitis]] is present. | |||
==Medical Therapy== | ==Medical Therapy== | ||
=== | ===Antimicrobial Medications=== | ||
Erythromycin, | *[[Erythromycin]], [[Tetracyclines]], [[Chloramphenicol]], or [[Penicillins]] have all been shown to be effective for treating [[tick-borne relapsing fever]] [[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 [[Borrelia recurrentis|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 [[Tick-borne relapsing fever|TBRF]]. | |||
For young children and pregnant women either | ===Antimicrobial regimen=== | ||
===Tick-Borne Relapsing Fever=== | |||
:* Preferred regimen: [[Doxycycline]] 100 mg PO bid for 5-10 days<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref> | |||
:* Alternative regimen: [[Erythromycin]] 500 mg PO qid for 5-10 days | :* 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 | :* 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 | :* Preferred regimen: [[Tetracycline]] 500 mg PO single dose | ||
:* Alternative regimen: [[Erythromycin]] 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|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== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Bacterial diseases]] | [[Category:Bacterial diseases]] | ||
[[Category:Zoonoses]] | [[Category:Zoonoses]] | ||
[[Category:Infectious diseases]] | [[Category:Infectious diseases]] | ||
[[Category:Infectious Disease Project]] | [[Category:Infectious Disease Project]] | ||
Latest revision as of 16:39, 25 September 2020
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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.