From the Guidelines
The drug of choice for treating yersiniosis is typically trimethoprim-sulfamethoxazole (TMP-SMX), with cefotaxime or ciprofloxacin as alternative options. According to the 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea 1, TMP-SMX is the first-line treatment for Yersinia enterocolitica. This recommendation is based on the guidelines' table 6, which lists the recommended antimicrobial agents by pathogen.
For adults, the dosage and duration of treatment may vary depending on the severity of the infection and the patient's overall health. In general, TMP-SMX is prescribed at a dose of 160/800 mg twice daily for 7-10 days. Cefotaxime or ciprofloxacin may be used as alternative treatments, especially in cases where TMP-SMX is not suitable or effective.
It's worth noting that the 2013 guidelines from the German Society of Hematology and Oncology 1 also suggest treatment with a fluoroquinolone or trimethoprim-sulfamethoxazole (TMP-SMZ) or doxycycline for infections caused by Yersinia spp. However, the more recent guidelines from 2017 1 take precedence in this case.
Some key points to consider when treating yersiniosis include:
- Most cases of yersiniosis are self-limiting and resolve without antibiotics within 1-3 weeks
- Treatment is primarily recommended for severe infections, systemic disease, or in immunocompromised patients
- Antibiotic therapy works by inhibiting bacterial protein synthesis or DNA replication, preventing the Yersinia bacteria from multiplying
- Supportive care with adequate hydration is also important, especially in patients with diarrhea
- If septicemia or other invasive complications are present, intravenous antibiotics may be necessary.
From the FDA Drug Label
Doxycycline is also indicated for the treatment of infections caused by the following gram-negative microorganisms: ... Plague due to Yersinia pestis (formerly Pasteurella pestis). ... However, Yersiniosis is typically caused by Yersinia enterocolitica or Yersinia pseudotuberculosis, not Yersinia pestis. The FDA drug label does not answer the question.
From the Research
Treatment Options for Yersiniosis
The drug of choice for treating yersiniosis depends on the severity of the infection and the patient's overall health.
- For uncomplicated cases, treatment may not be necessary as the infection is usually self-limiting 2.
- However, for compromised hosts or patients with septicemia or invasive infection, fluoroquinolones or third-generation cephalosporins are recommended 2.
- Other effective treatment options include:
- Cefotaxime, which has been shown to be effective in treating bacteremia in patients with yersiniosis 3, 4.
- Ciprofloxacin, which has been effective in treating experimental Yersinia enterocolitica O9 infection in mice 5.
- Trimethoprim-sulfamethoxazole, which has been shown to be effective in treating yersiniosis in children 4.
- Antibiotics such as ampicillin, ticarcillin, and cefazolin are not recommended due to high resistance rates 3.
- The role of quinolones in yersiniosis needs further attention, but they have shown promise in treating the infection 6.