From the Guidelines
Treatment for leptospirosis should be initiated upon suspicion, with penicillin and tetracycline antibiotics being effective during the bacteraemic phase, as recommended by most infectious disease specialists despite a systematic review showing no benefit for antibiotic treatment in established leptospirosis 1. The primary goal is to reduce morbidity, mortality, and improve quality of life, and in the context of leptospirosis, early treatment is crucial.
- Key considerations for treatment include:
- Early mild disease is generally self-limiting
- Patients presenting with classical symptoms and signs of Weils disease, such as jaundice, can become very unwell despite therapy and may require renal or liver support
- Antibiotics, such as penicillin and tetracycline, are thought to be effective during the bacteraemic phase, although the evidence is not conclusive 1
- In clinical practice, the treatment approach may vary depending on the severity of the disease and the patient's overall condition, with severe cases requiring hospitalization and supportive care, including fluid replacement, respiratory support, and monitoring for complications like kidney or liver failure.
- It is essential to note that while the systematic review showed no benefit for antibiotic treatment in established leptospirosis, most infectious disease specialists continue to recommend antibiotics, highlighting the importance of clinical judgment and individualized patient care 1.
From the Research
Treatment Options for Leptospirosis
- The optimal antimicrobial treatment for leptospirosis has not been established, but several antibiotics have been found to be effective in treating the disease 2.
- Penicillin has long been considered the treatment of choice, but concerns exist regarding its use in all patients 2.
- Doxycycline is a reasonable alternative and has been shown to be effective in reducing the duration of illness and preventing leptospiruria 2, 3.
- Cefotaxime and ceftriaxone are also acceptable agents and may be preferred due to their efficacy and safety profile 2.
- Azithromycin appears promising for the treatment of less severe disease, but more research is needed to confirm its effectiveness 2.
- Fluoroquinolone antimicrobials may also be an option, but adequate human trials are lacking to fully support their use 2.
Efficacy of Antibiotic Treatment
- A meta-analysis found no effect of penicillin treatment on mortality compared to placebo, and no differences between penicillin and cephalosporins or doxycycline 4.
- Doxycycline has been shown to be effective in reducing the duration of illness and preventing leptospiruria, but its effectiveness in preventing symptomatic infection is unclear 4, 3.
- A case report found that combined doxycycline and ceftriaxone therapy was effective in treating leptospirosis, with the patient showing significant improvement after treatment 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 may have a beneficial effect, but more research is needed to confirm this finding 4.
- None of the other chemoprophylaxis regimens tested have shown a statistically significant effect on the number of new symptomatic cases 4.