Tularemia medical therapy
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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]
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