From the Guidelines
The recommended treatment for Mediterranean spotted fever is doxycycline, which should be administered as soon as the disease is suspected, without waiting for laboratory confirmation. This is based on the fact that Mediterranean spotted fever can be severe or fatal, with a case-fatality rate of 21% among hospitalized adults in Portugal 1. The use of doxycycline is supported by the fact that Mediterranean spotted fever responds readily to antibacterial treatment with this antibiotic 1.
Key Considerations for Treatment
- The dose of doxycycline for adults is typically 100 mg twice daily, while for children under 45 kg, it is 2.2 mg/kg twice daily 1.
- Treatment duration is usually 7-14 days, depending on clinical response.
- Alternative antibiotics such as chloramphenicol, fluoroquinolones like ciprofloxacin, or macrolides like azithromycin can be used for patients who cannot take doxycycline, though these are considered second-line options.
- Pregnant women should avoid doxycycline and instead use josamycin (3 g/day for 7 days) due to the potential risks associated with doxycycline in pregnancy.
Rationale for Doxycycline Use
- Doxycycline targets the causative organism Rickettsia conorii, an intracellular bacterium transmitted by tick bites, by inhibiting protein synthesis.
- Most patients show improvement within 48-72 hours after starting treatment, with fever typically resolving within 2-4 days.
- Early intervention with doxycycline improves outcomes, highlighting the importance of initiating treatment as soon as Mediterranean spotted fever is suspected, without waiting for laboratory confirmation 1.
Additional Care
- Supportive care, including adequate hydration and fever management with acetaminophen, is also crucial in the management of Mediterranean spotted fever.
- Monitoring for severe manifestations such as neurologic, cardiac, and renal complications is essential, given that Mediterranean spotted fever can have severe or fatal outcomes if not properly managed 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. The recommended treatment for Mediterranean spotted fever is not explicitly stated in the provided drug label. However, it can be inferred that doxycycline may be used to treat Mediterranean spotted fever, as it is caused by Rickettsiae, which is mentioned in the indications for doxycycline.
- Key points:
- Doxycycline is indicated for the treatment of infections caused by Rickettsiae.
- Mediterranean spotted fever is caused by Rickettsiae.
- The drug label does not explicitly mention Mediterranean spotted fever as an indication for doxycycline. 2
From the Research
Treatment Options for Mediterranean Spotted Fever
The recommended treatment for Mediterranean spotted fever (MSF) is based on several studies that have evaluated the efficacy of different antibiotics.
- Tetracyclines, such as doxycycline, are considered the treatment of choice for MSF 3, 4, 5.
- Chloramphenicol is also effective, but its use is limited due to the risk of bone marrow toxicity 3, 4.
- Macrolides, such as clarithromycin and azithromycin, have been shown to be effective alternatives to tetracyclines and chloramphenicol, especially in children and pregnant women 3, 4, 6, 7.
- Ciprofloxacin has also been evaluated as a treatment option for MSF and has been shown to be effective and safe 5.
Specific Treatment Recommendations
- For adults, doxycycline or tetracycline is recommended as the first-line treatment 3, 4, 5.
- For children under 8 years old, clarithromycin or azithromycin is recommended as a safer alternative to tetracyclines 3, 6, 7.
- For pregnant women, clarithromycin or azithromycin may be considered as an alternative to tetracyclines or chloramphenicol 4, 7.