Leptospirosis medical therapy: Difference between revisions
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{{Leptospirosis}} | {{Leptospirosis}} | ||
{{CMG}} {{AE}} {{Maliha}} | {{CMG}} {{AE}} {{Maliha}}{{VSKP}} | ||
==Overview== | ==Overview== | ||
All patients with suspected leptospirosis require antimicrobial therapy. Antimicrobial therapy is the mainstay of therapy for Leptospirosis. Antimicrobial therapies include either [[penicillin]], [[ampicillin]], [[doxycycline]] | All patients with suspected leptospirosis require [[antimicrobial]] therapy. [[Antimicrobial drug|Antimicrobial]] therapy is the mainstay of therapy for Leptospirosis. [[Antimicrobial]] therapies include either [[penicillin]], [[ampicillin]], [[doxycycline]] or [[ceftriaxone]]. Patients with [[meningitis]] often require high-dose [[penicillin]], whereas patients with [[Weil's disease]] often require either [[azithromycin]] or [[doxycycline]]. Supportive measures include [[detoxification]] and normalization of [[electrolyte]] imbalances. [[Dialysis]] is reserved for patients with severe disease who fail antimicrobial therapy. | ||
==Medical Therapy== | ==Medical Therapy== | ||
All patients with suspected leptospirosis require antimicrobial therapy. For effective treatment of leptospirosis, [[antibiotics]] should be used within 5th day after the onset of symptoms and as soon as the diagnosis of leptospirosis is suspected without waiting for the laboratory results.<ref>{{cite book | last = LastName | first = FirstName | title = Human leptospirosis : guidance for diagnosis, surveillance and control | publisher = World Health Organization | location = Geneva | year = 2003 | isbn = 9241545895 }}</ref> Best initial treatment for severe leptospirosis is penicillin. For less severe form, drugs such as [[amoxicillin]], [[ampicillin]], [[doxycycline]] or [[erythromycin]] can be used. Other drugs of choice which are effective, include third-generation [[cephalosporins]] such as [[ceftriaxone]] and [[cefotaxime]], and [[quinolone]] [[antibiotics]].<ref>{{cite book | last = LastName | first = FirstName | title = Human leptospirosis : guidance for diagnosis, surveillance and control | publisher = World Health Organization | location = Geneva | year = 2003 | isbn = 9241545895 }}</ref> | |||
===Supportive Care=== | ===Supportive Care=== | ||
Supportive care for patients with leptospirosis includes the following:<ref name=WHO>{{Citation |year=2003 |title=Human Leptospirosis: Guidance for Diagnosis, Surveillance and Control |publisher=World Health Organization |url=http://www.who.int/csr/don/en/WHO_CDS_CSR_EPH_2002.23.pdf |accessdate=Accessed on October 19 2015 }}</ref><ref name=Sanford> {{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref> | |||
*Detoxification | * [[Detoxification]] | ||
*Correction of electrolyte imbalances | * Correction of [[electrolyte]] imbalances | ||
*Administration of glucose and salt solutions | * Administration of [[glucose]] and salt solutions | ||
* For patient with [[pulmonary]] manifestations, [[corticosteroids]] ([[Prednisolone]] 1000mg daily IV X 3 days, followed by oral [[prednisolone]] at 1 mg/kg X 7 days) offered benefit if given within 12 hours of the onset of pulmonary symptoms. | |||
===Antimicrobial regimen=== | ===Antimicrobial regimen=== | ||
*'''Antimicrobial Therapy'''<ref name=WHO>{{Citation |year=2003 |title=Human Leptospirosis: Guidance for Diagnosis, Surveillance and Control |publisher=World Health Organization |url=http://www.who.int/csr/don/en/WHO_CDS_CSR_EPH_2002.23.pdf |accessdate=Accessed on October 19 2015 }}</ref><ref name=Sanford> {{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref> | *'''Antimicrobial Therapy'''<ref name=WHO>{{Citation |year=2003 |title=Human Leptospirosis: Guidance for Diagnosis, Surveillance and Control |publisher=World Health Organization |url=http://www.who.int/csr/don/en/WHO_CDS_CSR_EPH_2002.23.pdf |accessdate=Accessed on October 19 2015 }}</ref><ref name=Sanford> {{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref> | ||
:* Preferred regimen: [[Penicillin]] 1.5 million units IV q6h for 7 days | :* Preferred regimen: [[Penicillin]] 1.5 million units IV q6h for 7 days | ||
:* Alternative regimen: [[Ampicillin]] 0.5-1 g IV q6h for 7 days {{or}} [[Doxycycline]] 100 mg IV/PO up to 100 mg q12h for 7 days {{or}} [[Ceftriaxone]] 1 g IV q24h for 7 days | :* Alternative regimen: [[Ampicillin]] 0.5-1 g IV q6h for 7 days {{or}} [[Doxycycline]] 100 mg IV/PO up to 100 mg q12h for 7 days {{or}} [[Ceftriaxone]] 1 g IV q24h for 7 days<ref name="pmid17075327">{{cite journal| author=Griffith ME, Hospenthal DR, Murray CK| title=Antimicrobial therapy of leptospirosis. | journal=Curr Opin Infect Dis | year= 2006 | volume= 19 | issue= 6 | pages= 533-7 | pmid=17075327 | doi=10.1097/QCO.0b013e3280106818 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17075327 }} </ref><ref name="pmid12802748">{{cite journal| author=Panaphut T, Domrongkitchaiporn S, Vibhagool A, Thinkamrop B, Susaengrat W| title=Ceftriaxone compared with sodium penicillin g for treatment of severe leptospirosis. | journal=Clin Infect Dis | year= 2003 | volume= 36 | issue= 12 | pages= 1507-13 | pmid=12802748 | doi=10.1086/375226 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12802748 }} </ref> | ||
:* Note: [[Jarisch-Herxheimer]] reaction may develop upon administration of antimicrobial therapy | :* Note: [[Jarisch-Herxheimer]] reaction may develop upon administration of antimicrobial therapy<ref name="pmid21527810">{{cite journal| author=Kolwijck E, Dofferhoff AS, van de Leur J, Meis JF| title=Leptospirosis in a Dutch catfish farm. | journal=Neth J Med | year= 2011 | volume= 69 | issue= 4 | pages= 201-4 | pmid=21527810 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21527810 }} </ref> | ||
===Special Considerations=== | ===Special Considerations=== | ||
*'''1. Meningitis due to leptospirosis'''<ref name=WHO>{{Citation |year=2003 |title=Human Leptospirosis: Guidance for Diagnosis, Surveillance and Control |publisher=World Health Organization |url= |accessdate=Accessed on October 19 2015 }}</ref> | *'''1. Meningitis due to leptospirosis'''<ref name=WHO>{{Citation |year=2003 |title=Human Leptospirosis: Guidance for Diagnosis, Surveillance and Control |publisher=World Health Organization |url= |accessdate=Accessed on October 19 2015 }}</ref> | ||
| Line 28: | Line 30: | ||
:*Alternative regimen:[[Doxycycline]] 100 mg IV/PO up to 100 mg q12h for 7 days | :*Alternative regimen:[[Doxycycline]] 100 mg IV/PO up to 100 mg q12h for 7 days | ||
===Dialysis=== | ===Dialysis=== | ||
*Dialysis is often reserved to patients who fail to respond to antimicrobial therapy.<ref name=WHO>{{Citation |year=2003 |title=Human Leptospirosis: Guidance for Diagnosis, Surveillance and Control |publisher=World Health Organization |url=http://www.who.int/csr/don/en/WHO_CDS_CSR_EPH_2002.23.pdf |accessdate=Accessed on October 19 2015 }}</ref><ref name=Sanford> {{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref> | *[[Dialysis]] is often reserved to patients who fail to respond to antimicrobial therapy.<ref name=WHO>{{Citation |year=2003 |title=Human Leptospirosis: Guidance for Diagnosis, Surveillance and Control |publisher=World Health Organization |url=http://www.who.int/csr/don/en/WHO_CDS_CSR_EPH_2002.23.pdf |accessdate=Accessed on October 19 2015 }}</ref><ref name=Sanford> {{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref> | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Infectious Disease Project]] | |||
[[Category:Emergency mdicine]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | [[Category:Infectious disease]] | ||
[[Category: | [[Category:Pulmonology]] | ||
[[Category:Gastroenterology]] | |||
[[Category:Otolaryngology]] | |||
[[Category:Neurology]] | |||
Latest revision as of 22:29, 29 July 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]Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [3]
Overview
All patients with suspected leptospirosis require antimicrobial therapy. Antimicrobial therapy is the mainstay of therapy for Leptospirosis. Antimicrobial therapies include either penicillin, ampicillin, doxycycline or ceftriaxone. Patients with meningitis often require high-dose penicillin, whereas patients with Weil's disease often require either azithromycin or doxycycline. Supportive measures include detoxification and normalization of electrolyte imbalances. Dialysis is reserved for patients with severe disease who fail antimicrobial therapy.
Medical Therapy
All patients with suspected leptospirosis require antimicrobial therapy. For effective treatment of leptospirosis, antibiotics should be used within 5th day after the onset of symptoms and as soon as the diagnosis of leptospirosis is suspected without waiting for the laboratory results.[1] Best initial treatment for severe leptospirosis is penicillin. For less severe form, drugs such as amoxicillin, ampicillin, doxycycline or erythromycin can be used. Other drugs of choice which are effective, include third-generation cephalosporins such as ceftriaxone and cefotaxime, and quinolone antibiotics.[2]
Supportive Care
Supportive care for patients with leptospirosis includes the following:[3][4]
- Detoxification
- Correction of electrolyte imbalances
- Administration of glucose and salt solutions
- For patient with pulmonary manifestations, corticosteroids (Prednisolone 1000mg daily IV X 3 days, followed by oral prednisolone at 1 mg/kg X 7 days) offered benefit if given within 12 hours of the onset of pulmonary symptoms.
Antimicrobial regimen
- Preferred regimen: Penicillin 1.5 million units IV q6h for 7 days
- Alternative regimen: Ampicillin 0.5-1 g IV q6h for 7 days OR Doxycycline 100 mg IV/PO up to 100 mg q12h for 7 days OR Ceftriaxone 1 g IV q24h for 7 days[5][6]
- Note: Jarisch-Herxheimer reaction may develop upon administration of antimicrobial therapy[7]
Special Considerations
- 1. Meningitis due to leptospirosis[3]
- Preferred regimen: Penicillin 5 million units IV q6h for 7 days
- Alternative regimen: Ampicillin 0.5-1 g IV q6h for 7 days OR Doxycycline 100 mg IV/PO up to 100 mg q12h for 7 days OR Ceftriaxone 1 g IV q24h for 7 days
- Preferred regimen: Azithromycin 1 g IV once THEN 500 mg IV q24h for 2 days
- Alternative regimen:Doxycycline 100 mg IV/PO up to 100 mg q12h for 7 days
Dialysis
References
- ↑ LastName, FirstName (2003). Human leptospirosis : guidance for diagnosis, surveillance and control. Geneva: World Health Organization. ISBN 9241545895.
- ↑ LastName, FirstName (2003). Human leptospirosis : guidance for diagnosis, surveillance and control. Geneva: World Health Organization. ISBN 9241545895.
- ↑ 3.0 3.1 3.2 3.3 3.4 Human Leptospirosis: Guidance for Diagnosis, Surveillance and Control (PDF), World Health Organization, 2003, retrieved Accessed on October 19 2015 Check date values in:
|accessdate=(help) - ↑ 4.0 4.1 4.2 4.3 Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Griffith ME, Hospenthal DR, Murray CK (2006). "Antimicrobial therapy of leptospirosis". Curr Opin Infect Dis. 19 (6): 533–7. doi:10.1097/QCO.0b013e3280106818. PMID 17075327.
- ↑ Panaphut T, Domrongkitchaiporn S, Vibhagool A, Thinkamrop B, Susaengrat W (2003). "Ceftriaxone compared with sodium penicillin g for treatment of severe leptospirosis". Clin Infect Dis. 36 (12): 1507–13. doi:10.1086/375226. PMID 12802748.
- ↑ Kolwijck E, Dofferhoff AS, van de Leur J, Meis JF (2011). "Leptospirosis in a Dutch catfish farm". Neth J Med. 69 (4): 201–4. PMID 21527810.