What is the treatment for Leptospirosis?

Treatment of Leptospirosis

Doxycycline 100 mg orally twice daily for 7 days is the recommended first-line treatment for mild to moderate cases of leptospirosis, with treatment initiated promptly upon clinical suspicion without waiting for laboratory confirmation. 1

Antibiotic Treatment Options

Mild to Moderate Disease

• First-line: Doxycycline 100 mg orally twice daily for 7 days 1
• Alternatives:
  • Azithromycin (for those who cannot take doxycycline)
  • Amoxicillin
  • Ampicillin

Severe Disease (Weil's Syndrome)

• First-line: Intravenous antibiotics 1
  • Penicillin G: 1.5 million IU IV every 6 hours for 7 days
  • Ceftriaxone: 1-2 g IV daily for 7 days
  • Ampicillin: 1 g IV every 6 hours for 7 days

Special Populations

• Pregnant patients: Avoid doxycycline; use penicillin G or erythromycin instead 1

Timing of Treatment

Early treatment is crucial for optimal outcomes:

• Begin antibiotics within the first 4-5 days of illness for maximum effectiveness 1
• Start treatment based on clinical suspicion without waiting for laboratory confirmation 1
• Clinical improvement typically occurs within 48-72 hours of appropriate antibiotic therapy 1
• Fever usually resolves within 2 days of starting antibiotics 1

Supportive Care

For severe cases with organ involvement:

• Fluid and electrolyte management
• Dialysis for acute kidney injury
• Respiratory support for ARDS
• Platelet transfusions for severe thrombocytopenia with bleeding
• Monitoring of liver and kidney function tests until normalized 1

Prognostic Factors

Two factors independently predict progression to severe leptospirosis:

1. Clinical jaundice
2. Cardiac damage (clinical or ECG findings) 2

These factors can be identified at initial examination and should prompt more aggressive management 2.

Clinical Phases and Monitoring

Leptospirosis typically presents in two phases:

1. Septicemic phase (4-7 days): High fever, headache, muscle pain, influenza-like symptoms 1
2. Immune phase (after 7-10 days): Characterized by circulating antibodies that can cause immunomediated manifestations such as meningitis, uveitis, and exanthema 1

Monitor for complications including:

• Hepatorenal syndrome
• Hemorrhagic manifestations
• Acute respiratory distress syndrome
• Meningitis
• Myocarditis or pericarditis 1, 2

Treatment Efficacy

Early antibiotic therapy combined with supportive care significantly reduces mortality 3. Leptospires are sensitive to various antimicrobials, but early initiation of therapy is critical for better outcomes 3.

Common Pitfalls

1. Delayed diagnosis: Leptospirosis often mimics other febrile illnesses, leading to misdiagnosis and delayed treatment 4
2. Inadequate treatment duration: Short courses of antibiotics may be insufficient; complete the full 7-day course 1
3. Failure to recognize severe disease: Watch for signs of organ involvement (jaundice, renal failure, respiratory distress) 2
4. Inadequate monitoring: Regular assessment of liver and kidney function is essential 1

Early recognition and prompt antibiotic treatment are the cornerstones of effective management of leptospirosis, with the choice of antibiotic and route of administration determined by disease severity.