Relapsing fever medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
[[Erythromycin]], [[Tetracyclines]], [[Chloramphenicol]], or [[Penicillins]] have all been shown to be effective for treating tick-borne relapsing fever | ===Antimicrobial Medications=== | ||
*[[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 TBRF. | *For young children and pregnant women either [[Erythromycin]] and/or [[Penicillin]] are recommended for the treatment of [[Tick-borne relapsing fever|TBRF]]. | ||
===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. | 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]]. | ||
===Antimicrobial regimen=== | ===Antimicrobial regimen=== | ||
===Tick-Borne Relapsing Fever===<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> | |||
:* Preferred regimen: [[Doxycycline]] 100 mg PO bid for 5-10 days | :* Preferred regimen: [[Doxycycline]] 100 mg PO bid for 5-10 days | ||
:* 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 |
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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]
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.
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.
Antimicrobial regimen
===Tick-Borne Relapsing Fever===[1]
- Preferred regimen: Doxycycline 100 mg PO bid 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
Louse-Borne Relapsing Fever
- Preferred regimen: Tetracycline 500 mg PO single dose
- Alternative regimen: Erythromycin 500 mg PO single dose
References
- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.