Tularemia medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
The drug of choice is [[Streptomycin]].<ref>{{cite journal | author=Enderlin G, Morales L, Jacobs RF, Cross JT | title=Streptomycin and alternative agents for the treatment of tularemia: review of the literature | journal=Clin Infect Dis | year=1994 | volume=19 | pages=42–7 }}</ref> Tularemia may also be treated with [[Gentamicin]], [[Tetracycline]]s, [[Chloramphenicol]] or [[Fluoroquinolone]]s. | The drug of choice is [[Streptomycin]].<ref>{{cite journal | author=Enderlin G, Morales L, Jacobs RF, Cross JT | title=Streptomycin and alternative agents for the treatment of tularemia: review of the literature | journal=Clin Infect Dis | year=1994 | volume=19 | pages=42–7 }}</ref> Tularemia may also be treated with [[Gentamicin]], [[Tetracycline]]s, [[Chloramphenicol]] or [[Fluoroquinolone]]s. | ||
*In a contained casualty setting, where individual patient management is possible, the working group recommends [[parenteral]] antimicrobial therapy. [[Streptomycin]] is the drug of choice. [[Gentamicin]], which is more widely available and can be used intravenously, is an acceptable alternative. Treatment with [[Aminoglycosides]] should be continued for 10 days. [[Tetracyclines]] and [[Chloramphenicol]] are also used, but relapses and primary treatment failures occur at a higher rate with these bacteriostatic agents than with | *In a contained casualty setting, where individual patient management is possible, the working group recommends [[parenteral]] antimicrobial therapy. [[Streptomycin]] is the drug of choice. [[Gentamicin]], which is more widely available and can be used intravenously, is an acceptable alternative. Treatment with [[Aminoglycosides]] should be continued for 10 days. [[Tetracyclines]] and [[Chloramphenicol]] are also used, but relapses and primary treatment failures occur at a higher rate with these [[Bacteriostatic agent|bacteriostatic]] agents than with Aminogylcosides, and they should be given for at least 14 days to avoid relapse. Both [[Streptomycin]] and [[Gentamicin]] are recommended as first-line treatment of tularemia in children. | ||
*In a mass casualty setting, [[Doxycycline]] and [[Ciprofloxacin]], administered orally, are the preferred choices for treatment of both adults and children. As described in the table below, 'Treatment with [[Ciprofloxacin]] should be continued for 10 days; treatment with [[Doxycycline]] should be continued for 14-21 days.' | *In a mass casualty setting, [[Doxycycline]] and [[Ciprofloxacin]], administered orally, are the preferred choices for treatment of both adults and children. As described in the table below, 'Treatment with [[Ciprofloxacin]] should be continued for 10 days; treatment with [[Doxycycline]] should be continued for 14-21 days.' | ||
*Since it is unknown whether drug-resistant organisms might be used in a bioterrorist event, antimicrobial susceptibility testing of isolates should be conducted quickly and treatments altered according to test results and clinical responses. | *Since it is unknown whether drug-resistant organisms might be used in a bioterrorist event, antimicrobial susceptibility testing of isolates should be conducted quickly and treatments altered according to test results and clinical responses. | ||
*Antibiotics for treating patients infected with tularemia in a bioterrorist event are included in the national pharmaceutical stockpile maintained by CDC, as are ventilators and other emergency equipment.<ref>http://www.bt.cdc.gov/agent/tularemia/facts.asp</ref><ref>http://www.bt.cdc.gov/agent/tularemia/tularemia-biological-weapon-abstract.asp#2</ref> | *[[Antibiotic|Antibiotics]] for treating patients infected with tularemia in a bioterrorist event are included in the national pharmaceutical stockpile maintained by CDC, as are ventilators and other emergency equipment.<ref>http://www.bt.cdc.gov/agent/tularemia/facts.asp</ref><ref>http://www.bt.cdc.gov/agent/tularemia/tularemia-biological-weapon-abstract.asp#2</ref> | ||
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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 tularemia is antimicrobial therapy. The drug of choice is Streptomycin. Other pharmacologic therapies for tularemia include Gentamicin, Tetracyclines, Chloramphenicol, or Fluoroquinolones.
Medical Therapy
The drug of choice is Streptomycin.[1] Tularemia may also be treated with Gentamicin, Tetracyclines, Chloramphenicol or Fluoroquinolones.
- In a contained casualty setting, where individual patient management is possible, the working group recommends parenteral antimicrobial therapy. Streptomycin is the drug of choice. Gentamicin, which is more widely available and can be used intravenously, is an acceptable alternative. Treatment with Aminoglycosides should be continued for 10 days. Tetracyclines and Chloramphenicol are also used, but relapses and primary treatment failures occur at a higher rate with these bacteriostatic agents than with Aminogylcosides, and they should be given for at least 14 days to avoid relapse. Both Streptomycin and Gentamicin are recommended as first-line treatment of tularemia in children.
- In a mass casualty setting, Doxycycline and Ciprofloxacin, administered orally, are the preferred choices for treatment of both adults and children. As described in the table below, 'Treatment with Ciprofloxacin should be continued for 10 days; treatment with Doxycycline should be continued for 14-21 days.'
- Since it is unknown whether drug-resistant organisms might be used in a bioterrorist event, antimicrobial susceptibility testing of isolates should be conducted quickly and treatments altered according to test results and clinical responses.
- Antibiotics for treating patients infected with tularemia in a bioterrorist event are included in the national pharmaceutical stockpile maintained by CDC, as are ventilators and other emergency equipment.[2][3]
Antimicrobial Regimen
- Tularemia treatment* For treatment and prophylaxis [4]
- Preferred regimen: Gentamicin 5 mg/kg/day PO bid
- Alternative regimen (1): Streptomycin 2 g/day IM q12h for 10 days
- Alternative regimen (2): Ciprofloxacin 800–1000 mg/day IV/PO q12h/bid for 10–14 days
- Alternative regimen (3): Doxycycline 200 mg/day PO bid for at least 15 days
- Pediatric regimen: Gentamicin 5–6 mg/kg/day q8-12h for at least 10 days; Streptomycin 15 mg/kg PO bid (Maximum, 2 g/day) for at least 10 days; Ciprofloxacin 15 mg/kg PO bid (Maximum, 1 g/day) for at least 10 days
References
- ↑ Enderlin G, Morales L, Jacobs RF, Cross JT (1994). "Streptomycin and alternative agents for the treatment of tularemia: review of the literature". Clin Infect Dis. 19: 42&ndash, 7.
- ↑ http://www.bt.cdc.gov/agent/tularemia/facts.asp
- ↑ http://www.bt.cdc.gov/agent/tularemia/tularemia-biological-weapon-abstract.asp#2
- ↑ LastName, FirstName (2007). WHO guidelines on tularaemia epidemic and pandemic alert and response. Geneva: World Health Organization. ISBN 9789241547376.