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

Antimicrobial therapy is the mainstay of therapy for Leptospirosis. Antimicrobial therapies include either penicillin G, 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 leptospirosis require antimicrobial therapy.

Supportive Care

• Supportive care for patients with leptospirosis includes the following:
• 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 (1): Treatment with effective antibiotics should be initiated as soon as the diagnosis of leptospirosis is suspected and preferably before the fifth day after the onset of illness
• Note (2): Clinicians should never wait for the results of laboratory tests before starting treatment with antibiotics because serological tests do not become positive until about a week after the onset of illness, and cultures may not become positive for several weeks.
• Note (3): Jarisch-Herxheimer reaction may develop upon administration of antimicrobial therapy

Special Considerations

• 1. Meningitis due to leptospirosis

• Preferred regimen: Penicillin 6 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

• 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.