What is Leptospirosis?

From the Guidelines

Leptospirosis requires prompt antibiotic treatment as soon as it is suspected, without waiting for laboratory confirmation, to improve outcomes and prevent complications. The infection is caused by Leptospira bacteria and can range from mild flu-like symptoms to severe disease with organ failure, characterized by haemorrhage, jaundice, and hepatorenal failure (Weil’s disease) 1.

Key Considerations

• The clinical presentation of leptospirosis varies, with a biphasic course including an initial bacteraemic phase with flu-like symptoms, followed by an immune phase with fever, myalgia, hepatorenal syndrome, and haemorrhage 1.
• Treatment should be initiated promptly, with oral doxycycline 100mg twice daily for 7 days recommended for mild cases, and intravenous penicillin G (1.5 million units every 6 hours) or ceftriaxone (1g daily) for 7 days preferred for severe cases requiring hospitalization.
• Supportive care, including hydration, fever management, and monitoring for complications like kidney failure or respiratory distress, is essential 1.

Prevention and Control

• Prevention involves avoiding potentially contaminated water, wearing protective clothing when in high-risk environments, and controlling rodent populations.
• Early recognition and treatment are crucial for preventing complications and improving outcomes in patients with leptospirosis 1.

From the Research

Overview of Leptospirosis

• Leptospirosis is a zoonotic disease that can cause significant morbidity and mortality worldwide 2, 3, 4, 5, 6
• The disease presents with symptoms ranging from fever, headache, nausea, and vomiting to life-threatening multiorgan failure 5

Treatment of Leptospirosis

• The optimal antimicrobial treatment for leptospirosis has not been established 2, 4, 6
• Commonly used antibiotics for treating leptospirosis include penicillin, doxycycline, cefotaxime, ceftriaxone, and azithromycin 2, 3, 4, 6
• Penicillin has long been considered the treatment of choice, but its effectiveness is still unclear 2, 3, 4, 6
• Doxycycline is a reasonable alternative, but concerns exist regarding its use in all patients 2
• Cefotaxime and ceftriaxone are also acceptable agents, and may be preferred in some cases 2
• Azithromycin appears promising for the treatment of less severe disease 2

Efficacy of Antibiotics

• Meta-analyses have shown no effect of penicillin treatment on mortality compared to placebo 4, 6
• There are no differences between penicillin and cephalosporins or doxycycline in terms of efficacy 4, 6
• Penicillin does not reduce the time of defervescence, hospital stay, or incidence of oliguria/anuria 6
• The use of penicillin does not demonstrate any effectiveness in terms of the need for dialysis treatment, time to creatinine normalization, incidence of jaundice, or liver function normalization time 6

Chemoprophylaxis

• Weekly doses of 200 mg of doxycycline do not show benefit versus placebo regarding the number of new cases of symptomatic leptospirosis 6
• A single dose of doxycycline at exposure to flood water could have a beneficial effect 6
• None of the other chemoprophylaxis regimens tested have shown a statistically significant effect on the number of new symptomatic cases 6