From the Guidelines
Doxycycline is the recommended treatment for Rickettsia infections, and it should be initiated immediately in patients with signs and symptoms suggestive of rickettsial disease, without waiting for laboratory confirmation 1.
Treatment and Management
The treatment of Rickettsia infections is crucial to prevent severe morbidity and mortality.
- The recommended dose of doxycycline for adults is 100 mg twice daily, and for children weighing less than 45 kg, the dose is 2.2 mg/kg twice daily 1.
- The duration of therapy should be at least 3 days after the subsidence of fever and until evidence of clinical improvement 1.
- Early empiric treatment with doxycycline can prevent severe disease and death, and it is essential to recognize the epidemiology and clinical manifestations of tickborne rickettsial diseases to make timely treatment decisions 1.
Prevention and Control
Prevention of Rickettsia infections focuses on avoiding tick and other arthropod bites through:
- Protective clothing
- Repellents
- Prompt removal of attached ticks It is also essential to recognize the risk factors, signs, and symptoms consistent with tickborne rickettsial diseases to increase the likelihood of an early and accurate diagnosis 1.
Clinical Considerations
Rickettsial diseases can progress rapidly and become life-threatening, and it is crucial to consider the potential for severe manifestations, such as vasculitis and organ damage 1.
- Health care providers should be familiar with the clinical history, physical examination, and laboratory results to develop a differential diagnosis and treatment plan 1.
- Coinfection with other tickborne pathogens should also be considered, and appropriate diagnostic tests should be ordered to confirm the diagnosis 1.
From the Research
Rickettsia Overview
- Rickettsia are small, obligately intracellular, gram-negative bacilli that cause illness throughout the world 2
- They are distributed among a variety of hematophagous arthropod vectors and present as an acute undifferentiated febrile illness 2
- Symptoms range from mild febrile illness to severe disease or death, and can include headache, myalgias, malaise, rash, and eschar 3, 2
Diagnosis and Treatment
- Serology is the mainstay of diagnosis, and the indirect immunofluorescence assay is the test of choice 2
- Doxycycline is the treatment of choice for patients of all ages, and early treatment based on clinical diagnosis is critical to prevent severe outcomes 4, 3, 2, 5, 6
- Other antibiotics, such as chloramphenicol and ciprofloxacin, may also be effective, but doxycycline is generally considered the most effective treatment 5, 6
Treatment Patterns and Outcomes
- Despite being the recommended treatment, doxycycline is not always prescribed for patients with rickettsial diseases, with prescription rates varying by diagnosis and age 4, 3
- A study of 14,830 patients with rickettsial diseases found that only 53.1% received doxycycline, with prescription rates ranging from 23.9% for persons under 8 years to 55.4% for persons over 18 years 3
- Continued education of treatment recommendations is critical to prevent severe outcomes and improve treatment patterns 3