From the Guidelines
Leptospirosis is a bacterial infection that requires prompt antibiotic treatment, with oral doxycycline or intravenous penicillin G being the recommended therapies, as suggested by 1.
Key Considerations
- The infection is typically contracted through contact with water or soil contaminated with urine from infected animals, particularly rodents, as noted in 1.
- Leptospirosis can range from mild flu-like illness to severe disease with multi-organ failure (Weil's disease), making early recognition and treatment crucial for preventing serious complications, as described in 1 and 1.
- Treatment should begin as soon as leptospirosis is suspected, without waiting for laboratory confirmation, as early intervention improves outcomes, as recommended in 1.
Treatment Options
- For mild cases, oral doxycycline 100mg twice daily for 7 days is the recommended first-line therapy.
- For severe cases requiring hospitalization, intravenous penicillin G (1.5 million units every 6 hours) or ceftriaxone (1g daily) for 7 days is preferred.
Supportive Care
- Supportive care including hydration, fever management, and monitoring for complications like kidney failure or respiratory distress is essential.
- Prevention involves avoiding potentially contaminated water, wearing protective clothing when in high-risk environments, and controlling rodent populations.
Clinical Presentation
- The clinical presentation of leptospirosis varies from mild flu-like symptoms to a severe illness characterized by haemorrhage, jaundice, and hepatorenal failure (Weil’s disease), as described in 1.
- Conjunctival suffusion is suggestive of leptospirosis, as noted in 1.
From the Research
Overview of Leptospirosis
- Leptospirosis is a zoonotic disease that can cause significant morbidity and mortality 2
- The disease is primarily transmitted through contact with animals or through exposure to contaminated water or soil 3
Treatment of Leptospirosis
- The optimal antimicrobial treatment for leptospirosis has not been established 2
- Commonly used antibiotics for treating leptospirosis include penicillin, doxycycline, cefotaxime, ceftriaxone, and azithromycin 2, 4
- A meta-analysis found no effect of penicillin treatment on mortality compared to placebo, and no differences between penicillin and cephalosporins or doxycycline 4
- A case report found that combined doxycycline and ceftriaxone therapy was effective in treating leptospirosis 3
Efficacy of Antibiotics
- The evidence is very uncertain about the effect of antibiotics on all-cause mortality, serious adverse events, or adverse events considered non-serious 5
- A systematic review found that antibiotics may be useful in treating leptospirosis, but the evidence is insufficient to provide clear guidelines for practice 6, 5
- The certainty of evidence is very low, and there is a lack of definitive rigorous data from randomized trials to support the use of antibiotics for treating leptospirosis infection 5
Chemoprophylaxis
- A weekly dose of 200 mg of doxycycline does not show benefit versus placebo regarding the number of new cases of symptomatic leptospirosis 4
- A single dose of doxycycline at exposure to flood water could have a beneficial effect 4
- None of the other chemoprophylaxis regimens tested have shown a statistically significant effect on the number of new symptomatic cases 4