Leptospirosis medical therapy
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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
All patients with suspected leptospirosis require antimicrobial therapy. Antimicrobial therapy is the mainstay of therapy for Leptospirosis. Antimicrobial therapies include either penicillin, 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 suspected leptospirosis require antimicrobial therapy.
- Therapy must be initiated as soon as the diagnosis is suspected. Confirmatory results (including culture and serology) may not be available until several days/weeks.
Supportive Care
- Supportive care for patients with leptospirosis includes the following:[1][2]
- 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: Jarisch-Herxheimer reaction may develop upon administration of antimicrobial therapy
Special Considerations
- 1. Meningitis due to leptospirosis[1]
- Preferred regimen: Penicillin 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
- 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
Medical Therapy
For effective treatment of leptospirosis, antibiotics should be used within 5th day after the onset of symptoms and as soon as the diagnosis of leptospirosis is suspected without waiting for the laboratory results.[3] Best initial treatment for severe leptospirosis is Penicillin. For less severe form, drugs such as amoxycillin, ampicillin, doxycycline or erythromycin can be used. Other drugs of choice which are effective, include third-generation cephalosporins, such as ceftriaxone and cefotaxime, and quinolone antibiotics.[4]
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Human Leptospirosis: Guidance for Diagnosis, Surveillance and Control (PDF), World Health Organization, 2003, retrieved Accessed on October 19 2015 Check date values in:
|accessdate=(help) - ↑ 2.0 2.1 2.2 2.3 Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ LastName, FirstName (2003). Human leptospirosis : guidance for diagnosis, surveillance and control. Geneva: World Health Organization. ISBN 9241545895.
- ↑ LastName, FirstName (2003). Human leptospirosis : guidance for diagnosis, surveillance and control. Geneva: World Health Organization. ISBN 9241545895.