Leptospirosis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Treatment
Leptospirosis treatment is a relatively complicated process comprising two main components - suppressing the causative agent and fighting possible complications. Aetiotropic drugs are antibiotics, such as doxycycline, penicillin, ampicillin, and amoxicillin (doxycycline can also be used as a prophylaxis). There are no human vaccines; animal vaccines are only for a few strains, and are only effective for a few months. Human therapeutic dosage of drugs is as follows: doxycycline 100 mg orally every 12 hours for 1 week or penicillin 1-1.5 MU every 4 hours for 1 week. Doxycycline 200-250 mg once a week is administered as a prophylaxis. In dogs, penicillin is most commonly used to end the leptospiremic phase (infection of the blood), and doxycycline is used to eliminate the carrier state.
Supportive therapy measures (esp. in severe cases) include detoxication and normalization of the hydro-electrolytic balance. Glucose and salt solution infusions may be administered; dialysis is used in serious cases. Elevations of serum potassium are common and if the potassium level gets too high special measures must be taken. Serum phosphorus levels may likewise increase to unacceptable levels due to renal failure. Treatment for hyperphosphatemia consists of treating the underlying disease, dialysis where appropriate, or oral administration of calcium carbonate, but not without first checking the serum calcium levels (these two levels are related). Corticosteroids administration in gradually reduced doses (e.g., prednisolone starting from 30-60 mg) during 7-10 days is recommended by some specialists in cases of severe haemorrhagic effects.
Antimicrobial regimen
- Preferred regimen: Penicillin 1.5 MU IV q6h for 5-7 days
- 2. Less severe
- Preferred regimen (1): Amoxycillin
- Preferred regimen (2): Ampicillin
- Preferred regimen (3): Doxycycline 100 mg IV/PO q12h/bid for 5-7 days
- Preferred regimen (4): Erythromycin
- Preferred regimen (5): Ceftriaxone 1 g IV q24h for 5-7 days
- Preferred regimen (6): Cefotaxime
- Preferred regimen (7): Quinolone PO
References
- ↑ LastName, FirstName (2003). Human leptospirosis guidance for diagnosis, surveillance and control. Geneva: World Health Organization. ISBN 9241545895.
- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.