Relapsing fever medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Antimicrobial therapy for Relapsing fever in adults depends on the vector (Tick-borne vs. Louse-borne) and includes either Doxycycline, Erythromycin, or Tetracyclines. Intravenous Ceftriaxone is added if either meningitis or encephalitis is present.
Medical Therapy
Erythromycin, tetracyclines, chloramphenicol, or penicillins have all been shown to be effective for treating TBRF. Although duration of therapy has not been well studied for TBRF, the current recommendation is seven days of antibiotic therapy. In contrast, LBRF caused by B. recurrentis can be treated with a single dose of antibiotics.
For young children and pregnant women either erythromycin and/or penicillin are recommended for treatment of TBRF.
When initiating antibiotic therapy, a patient should be watched closely for a Jarisch-Herxheimer reaction for the first 4 hours after the antibiotic is given (Negussie, Remick et al. 1992). The reaction may be difficult to distinguish from a febrile crisis, with rigors and decreased blood pressure. Cooling blankets and appropriate use of antipyrectic agents may be indicated.
Antimicrobial regimen
- 1. Tick-Borne Relapsing Fever [1]
- Preferred regimen: Doxycycline 100 mg PO bid for 5-10 days
- Alternative regimen: Erythromycin 500 mg PO qid for 5-10 days
- Note: If meningitis/encephalitis present, use Ceftriaxone 2 g IV q12h for 14 days
- 2. Louse-Borne Relapsing Fever
- Preferred regimen: Tetracycline 500 mg PO single dose
- Alternative regimen: Erythromycin 500 mg PO single dose
References
- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.