Rocky Mountain spotted fever medical therapy

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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 antimicrobial therapy. Pharmacologic therapy for rocky mountain spotted fever includes either Doxycycline or Chloramphenicol.

Medical Therapy

• 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.

• 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.

Antimicrobial regimen

Treatment Method	Regimen
Preferred regimen: Doxycycline	100 mg q12h
Pregnant or alternative method: Chloramphenicol
Pediatric regimen: Doxycycline	2.2 mg/kg PO bid (under 45 kg (100 lbs))

• Alternative regimen: Chloramphenicol especially in pregnant women, but requires close monitoring.**
• 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.

The best way to remove a tick

1. 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.
2. 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.)
3. After removing the tick, thoroughly disinfect the bite site and wash your hands with soap and water.

Tick removal process

1. 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.

Removal of an embedded tick using fine-tipped tweezers

1. 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.