From the Guidelines
For Rocky Mountain Spotted Fever in pediatric patients, doxycycline is the first-line treatment at a dose of 2.2 mg/kg per dose given twice daily (maximum 100 mg per dose), administered orally or intravenously for 5-7 days total. This recommendation is based on the most recent and highest quality study available, which emphasizes the importance of prompt treatment in reducing morbidity and mortality 1. The dose of 2.2 mg/kg per dose is recommended for children weighing less than 45 kg, with a maximum dose of 100 mg per dose 1.
Key Considerations
- Treatment should continue for at least 3 days after fever subsides and until evidence of clinical improvement 1.
- Early treatment is crucial, ideally within the first 5 days of illness, even before laboratory confirmation, as delayed therapy significantly increases mortality risk 1.
- Doxycycline is preferred over chloramphenicol due to its superior efficacy and safety profile 1.
- Short courses of doxycycline (less than 14 days) have not been shown to cause dental staining in children, which has led to revised recommendations supporting its use in all pediatric age groups for this potentially life-threatening infection 1.
Administration and Monitoring
- Doxycycline can be administered orally or intravenously, depending on the severity of the disease and the patient's ability to tolerate oral medication 1.
- Patients with severe disease or those who are hospitalized may require intravenous therapy, while oral therapy may be suitable for patients with mild disease who can be managed as outpatients 1.
From the FDA Drug Label
For children above eight years of age: The recommended dosage schedule for children weighing 100 pounds or less is 2 mg/lb of body weight divided into two doses on the first day of treatment, followed by 1 mg/lb of body weight given as a single daily dose or divided into two doses, on subsequent days.
Inhalational anthrax (post-exposure): CHILDREN: weighing less than 100 lb (45 kg); 1 mg/lb (2.2 mg/kg) of body weight, by mouth, twice a day for 60 days.
The dose of Doxycycline for Rocky Mountain Spotted Fever in pediatric patients is 2 mg/lb of body weight divided into two doses on the first day of treatment, followed by 1 mg/lb of body weight given as a single daily dose or divided into two doses, on subsequent days for children weighing 100 pounds or less, and the usual adult dose for children over 100 lb 2.
From the Research
Dose of Doxycycline in Rocky Mountain Spotted Fever in Pediatric Patients
- The dose of doxycycline for pediatric patients with Rocky Mountain Spotted Fever is not explicitly stated in the provided studies.
- However, the studies suggest that doxycycline is the treatment of choice for Rocky Mountain Spotted Fever in children, including those under 8 years old 3, 4, 5.
- According to 4, doxycycline is the most favorable agent for the treatment of RMSF in children younger than 9 years of age due to its documented effectiveness and broader margin of safety.
- The American Academy of Pediatrics recommends a dose of 2.2 mg/kg of doxycycline, given twice a day, for the treatment of RMSF in children, but this information is not present in the provided studies.
Treatment Considerations
- The treatment of RMSF should be initiated empirically, as delayed diagnosis can be fatal 3, 6.
- Doxycycline is the preferred treatment for RMSF in adults, children, and pregnant patients 3.
- The duration of treatment is typically 7-10 days or until the patient is afebrile for two to five days 7.