Tularemia medical therapy: Difference between revisions
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Revision as of 14:31, 12 August 2015
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Medical Therapy
The drug of choice is Streptomycin.[1] Tularemia may also be treated with gentamicin, tetracycline, 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[4]
- Preferred regimen (1): Streptomycin 15 mg/kg IM q12h OR Gentamicin 1.5 mg/kg IV q8h
- Preferred regimen (2): Tetracycline 500 mg qid OR doxycycline 100 mg bid PO (for mild cases)
- 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
- ↑ Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL; et al. (2014). "Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America". Clin Infect Dis. 59 (2): 147–59. doi:10.1093/cid/ciu296. PMID 24947530.