Yersinia pestis infection medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editors-In-Chief: Esther Lee, M.A.; João André Alves Silva, M.D. [2]
Overview
According to treatment experts, a patient diagnosed with suspected plague should be hospitalized and medically isolated. Laboratory tests should be done, including blood cultures for plague bacteria and microscopic examination of lymph gland, blood, and sputum samples. Antibiotic treatment should begin as soon as possible after laboratory specimens are taken. Effective antibiotics are streptomycin, gentamicin (used when streptomycin is not available), tetracyclines and chloramphenicol. (used for critically ill patients, or rarely for suspected neuro-involvement)
Medical Therapy
When a diagnosis of human plague is suspected on clinical and epidemiological grounds, appropriate specimens for diagnosis should be obtained immediately and the patient should be started on specific antimicrobial therapy without waiting for a definitive answer from the laboratory.[1][2]
Suspect plague patients with evidence of pneumonia should be placed in isolation, and managed under respiratory droplet precautions.[3]
Specific Therapy
Aminoglycosides
Streptomycin is the most effective antibiotic against Yersinia pestis and the drug of choice for treatment of plague, particularly the pneumonic form. Therapeutic effect may be expected with 30 mg/kg/day (up to a total of 2 g/day) in divided doses given intramuscularly, to be continued for a full course of 10 days of therapy or until 3 days after the temperature has returned to normal.[1][4][5][6][7]
Gentamicin has been found to be effective in animal studies, and is used to treat human plague patients.[1]
Chloramphenicol
Chloramphenicol is a suitable alternative to aminoglycosides in the treatment of bubonic or septicaemic plague and is the drug of choice for treatment of patients with Yersinia pestis invasion of tissue spaces into which other drugs pass poorly or not at all (such as plague meningitis, pleuritis, or endophthalmitis. Dosage should be 50 mg/kg/day administered in divided doses either parenterally or, if tolerated, orally for 10 days. Chloramphenicol may be used adjunctively with aminoglycosides.[1]
Tetracyclines
This group of antibiotics is bacteriostatic but effective in the primary treatment of patients with uncomplicated plague. An oral loading dose of 15 mg/kg tetracycline (not to exceed 1 g total) should be followed by 25-50 mg/kg/day (up to a total of 2 g/day) for 10 days. Tetracyclines may also be used adjunctively with other antibiotics.[1]
Sulfonamides
Sulfonamides have been used extensively in plague treatment and prevention: however, some studies have shown higher mortality, increased complications, and longer duration of fever as compared with the use of streptomycin, chloramphenicol or tetracycline antibiotics. Sulfadiazine is given as a loading dose of 2-4 g followed by a dose of 1 g every 4-6 hours for a period of 10 days. In children, the oral loading dose is 75 mg/kg, followed by 150 mg/kg/day orally in six divided doses. The combination drug trimethoprim-sulfamethoxazole has been used both in treatment and prevention of plague.[1]
Fluoroquinolones
Fluoroquinolones, such as ciprofloxacin, have been shown to have good effect against Y. pestis in both in vitro and animal studies. Ciprofloxacin is bacteriocidal and has broad spectrum activity against most Gram-negative aerobic bacteria, including Enterobacteriaceae and Pseudomonas aeruginosa, as well as against many Gram-positive bacteria. Although it has been used successfully to treat humans with Francisella tularensis infection, no studies have been published on its use in treating human plague.[1]
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 "Plague manual--epidemiology, distribution, surveillance and control". Wkly Epidemiol Rec. 74 (51–52): 447. 1999. PMID 10635759.
- ↑ Longo, Dan L. (Dan Louis) (2012). Harrison's principles of internal medici. New York: McGraw-Hill. ISBN 978-0-07-174889-6.
- ↑ Garner JS (1996). "Guideline for isolation precautions in hospitals. The Hospital Infection Control Practices Advisory Committee". Infect Control Hosp Epidemiol. 17 (1): 53–80. PMID 8789689.
- ↑ Longo, Dan L. (Dan Louis) (2012). Harrison's principles of internal medici. New York: McGraw-Hill. ISBN 978-0-07-174889-6.
- ↑ SMADEL JE, WOODWARD TE, AMIES CR, GOODNER K (1952). "Antibiotics in the treatment of bubonic and pneumonic plague in man". Ann N Y Acad Sci. 55 (6): 1275–84. PMID 13139207.
- ↑ Meyer, K. F.; Quan, S. F.; McCrumb, F. R.; Larson, A. (1952). "EFFECTIVE TREATMENT OF PLAGUE". Annals of the New York Academy of Sciences. 55 (6): 1228–1274. doi:10.1111/j.1749-6632.1952.tb22687.x. ISSN 0077-8923.
- ↑ Butler T, Levin J, Linh NN, Chau DM, Adickman M, Arnold K (1976). "Yersinia pestis infection in Vietnam. II. Quantiative blood cultures and detection of endotoxin in the cerebrospinal fluid of patients with meningitis". J Infect Dis. 133 (5): 493–9. PMID 1262715.