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]
- Detoxification
- Correction of electrolyte imbalances
- Administration of glucose and salt solutions
Antimicrobial regimen
- Antimicrobial Therapy[1]
- 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
- 2. Weil's disease[1]
- 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.[1]