From the Guidelines
Doxycycline is the first-line treatment for Rocky Mountain spotted fever (RMSF) in patients of all ages, including children, and should be initiated promptly upon suspicion of the disease, even before laboratory confirmation. The recommended dosage for adults is 100 mg twice daily, and for children weighing less than 45 kg, 2.2 mg/kg twice daily, as stated in the guidelines 1. Treatment should begin immediately, as delayed treatment significantly increases mortality risk. Some key points to consider when treating RMSF include:
- The typical duration of therapy is at least 7 days, continuing for at least 3 days after fever resolves, but may be longer in cases of severe or complicated disease 1.
- Despite traditional concerns about dental staining in children, the benefits of doxycycline in treating this potentially fatal disease outweigh this risk, which is minimal with short-course therapy.
- RMSF, caused by Rickettsia rickettsii and transmitted by tick bites, can rapidly progress to severe illness with symptoms including fever, headache, rash, and muscle pain.
- Early treatment is crucial because the infection can cause widespread vasculitis, leading to organ damage and death if not promptly addressed, highlighting the importance of prompt initiation of doxycycline therapy 1.
- Supportive care and monitoring for complications should accompany antibiotic treatment. It's also important to note that doxycycline is recommended by the American Academy of Pediatrics and CDC as the treatment of choice for patients of all ages, including children aged <8 years, with a suspected tickborne rickettsial disease 1.
From the FDA Drug Label
Doxycycline is indicated for the treatment of the following infections: Rocky Mountain spotted fever, typhus fever and the typhus group, Q fever, rickettsialpox, and tick fevers caused by Rickettsiae. Doxycycline is indicated for the treatment of Rocky Mountain spotted fever 2.
- The drug label directly supports the use of doxycycline for this condition.
- Doxycycline is a suitable treatment option for Rocky Mountain spotted fever.
From the Research
Treatment of Rocky Mountain Spotted Fever
- The disease is typically treated with rickettsiostatic agents, such as chloramphenicol or tetracycline 3.
- However, doxycycline is considered the most favorable agent for the treatment of Rocky Mountain spotted fever in children younger than 9 years of age due to its documented effectiveness and broader margin of safety 4.
- Doxycycline is also the drug of choice for infants and children less than 8 years old when Rocky Mountain spotted fever is suspected, and treatment should not be delayed pending confirmation of infection 5.
Use of Doxycycline in Children
- Doxycycline is the preferred treatment for Rocky Mountain spotted fever in children, with up to five courses administered with minimal risk of dental staining in cases of reinfection 4.
- Despite this, a survey found that only 35% of healthcare providers correctly chose doxycycline as the treatment for patients less than 8 years old, highlighting the need for targeted education efforts 6.