Leptospirosis medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
Antimicrobial therapy is the mainstay of therapy for Leptospirosis. | Antimicrobial therapy is the mainstay of therapy for Leptospirosis. Antimicrobial therapies include either penicillin G, 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 leptospirosis require antimicrobial therapy. | *All patients with leptospirosis require antimicrobial therapy. | ||
=== | ===Supportive Care=== | ||
* | *Supportive care for patients with leptospirosis includes the following: | ||
: | *Detoxification | ||
* | *Correction of electrolyte imbalances | ||
*Administration of glucose and salt solutions | |||
===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 | |||
* Note (1): Treatment with effective antibiotics should be initiated as soon as the diagnosis of leptospirosis is suspected and preferably before the fifth day after the onset of illness | |||
* Note (2): Clinicians should never wait for the results of laboratory tests before starting treatment with antibiotics because serological tests do not become positive until about a week after the onset of illness, and cultures may not become positive for several weeks. | |||
* Note (3): [[Jarisch-Herxheimer]] reaction may develop upon administration of antimicrobial therapy | |||
===Special Considerations=== | |||
*'''1. Meningitis due to leptospirosis''' | |||
:*Preferred regimen: [[Penicillin]] 6 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 | |||
*2. Weil's disease | |||
:*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=== | |||
*Dialysis is often reserved to patients who fail to respond to antimicrobial therapy. | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Infectious disease]] | [[Category:Infectious disease]] | ||
[[Category:Infectious Disease Project]] | [[Category:Infectious Disease Project]] | ||
Revision as of 13:54, 19 October 2015
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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 is the mainstay of therapy for Leptospirosis. Antimicrobial therapies include either penicillin G, 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 leptospirosis require antimicrobial therapy.
Supportive Care
- Supportive care for patients with leptospirosis includes the following:
- Detoxification
- Correction of electrolyte imbalances
- Administration of glucose and salt solutions
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
- Note (1): Treatment with effective antibiotics should be initiated as soon as the diagnosis of leptospirosis is suspected and preferably before the fifth day after the onset of illness
- Note (2): Clinicians should never wait for the results of laboratory tests before starting treatment with antibiotics because serological tests do not become positive until about a week after the onset of illness, and cultures may not become positive for several weeks.
- Note (3): Jarisch-Herxheimer reaction may develop upon administration of antimicrobial therapy
Special Considerations
- 1. Meningitis due to leptospirosis
- Preferred regimen: Penicillin 6 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
- 2. Weil's disease
- 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
- Dialysis is often reserved to patients who fail to respond to antimicrobial therapy.