From the Guidelines
Penicillin and tetracycline antibiotics are the recommended treatments for leptospirosis, particularly during the bacteraemic phase. According to a study published in the Journal of Infection in 2009 1, early mild disease is generally self-limiting, and these antibiotics are thought to be effective.
Key Points to Consider
- The non-specific nature of initial investigations means treatment should be based on suspicion
- 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
- A systematic review of antibiotic effectiveness in established leptospirosis showed no benefit for antibiotic treatment, but most infectious disease specialists continue to recommend antibiotics 1
Treatment Approach
- Penicillin and tetracycline antibiotics are the primary choices for treating leptospirosis
- The effectiveness of these antibiotics is thought to be highest during the bacteraemic phase, as noted in the study 1
- It is essential to start treatment early, ideally within the first few days of illness, to reduce the severity and duration of symptoms
- Patients should complete the full course of antibiotics, even if symptoms improve before completion, to ensure complete eradication of the bacteria
- Supportive care, including hydration, is also crucial, especially in severe cases with kidney or liver involvement 1
From the Research
Antibiotics Used for Leptospirosis
The following antibiotics have been studied for the treatment of leptospirosis:
- Penicillin: widely used for treating leptospirosis, with some studies suggesting it may cause more good than harm 2
- Doxycycline: used in combination with ceftriaxone to treat leptospirosis, with positive outcomes reported in a case study 3
- Ceftriaxone: used in combination with doxycycline to treat leptospirosis, with positive outcomes reported in a case study 3
- Azithromycin: compared to doxycycline, with very uncertain evidence regarding its effectiveness 4
- Cefotaxime: compared to doxycycline and penicillin, with very uncertain evidence regarding its effectiveness 5
- Chloramphenicol: compared to penicillin, with very uncertain evidence regarding its effectiveness 5
Efficacy of Antibiotics for Leptospirosis
The evidence for the efficacy of antibiotics in treating leptospirosis is limited and uncertain:
- A meta-analysis found no significant difference in mortality between penicillin and placebo 6
- A systematic review found very low-certainty evidence for the effectiveness of antibiotics in reducing mortality, serious adverse events, and hospital stay 5
- A review of antibiotic prophylaxis for leptospirosis found low-certainty evidence for the effectiveness of doxycycline in preventing laboratory-confirmed leptospirosis 4
Adverse Events Associated with Antibiotics for Leptospirosis
The evidence for adverse events associated with antibiotics for leptospirosis is limited and uncertain: