Treatment of Leptospirosis
Early antibiotic therapy with doxycycline 100 mg orally twice daily for 7 days is recommended for mild to moderate cases of leptospirosis, while intravenous penicillin G is preferred for severe cases. 1
Antibiotic Treatment Options
Mild to Moderate Cases
- First-line: Doxycycline 100 mg orally twice daily for 7 days 1
- Alternatives (especially for pregnant patients who should avoid doxycycline):
Severe Cases (requiring hospitalization)
- First-line: Penicillin G 1.5 million IU IV every 6 hours for 7 days 1
- Alternatives:
Timing of Treatment
Treatment should begin immediately upon clinical suspicion without waiting for laboratory confirmation, as antibiotics are most effective when started within the first 4-5 days of illness 1. This early intervention is critical for reducing mortality and preventing progression to severe disease.
Clinical Response to Treatment
Most patients show clinical improvement within 48-72 hours of appropriate antibiotic therapy, with fever typically resolving within 2 days of starting antibiotics 1. If a patient doesn't respond within this timeframe, reassessment of diagnosis and treatment approach is warranted.
Special Considerations
Pregnant Patients
Jarisch-Herxheimer Reaction
- Be aware that patients may experience a Jarisch-Herxheimer reaction after starting antibiotics, characterized by fever, chills, and hypotension 3
- This reaction is due to release of endotoxins from dying leptospires
- Supportive care is typically sufficient to manage this reaction
Supportive Care for Severe Cases
For patients with severe leptospirosis (Weil's syndrome), additional supportive measures are crucial:
- Fluid and electrolyte management
- Renal support (including dialysis if needed)
- Respiratory support for patients with pulmonary hemorrhage or ARDS
- Careful monitoring of liver function
- Management of bleeding complications if present
Monitoring During Treatment
- Follow liver and kidney function tests until normalized 1
- Monitor for potential complications, especially in patients presenting with jaundice or cardiac abnormalities, which are independent predictors of severe disease 4
- Regular assessment of platelet counts, as thrombocytopenia occurs in approximately 65% of patients 4
Prevention Strategies
While not part of treatment, prevention is important to mention:
- Use of personal protective equipment in high-risk workers
- Control of rodents
- Improvement of sanitation
- Vaccination of domestic animals and livestock
- Avoidance of swimming in potentially contaminated waters 1
Early recognition and prompt antibiotic therapy are the cornerstones of leptospirosis management, with the choice of antibiotic and route of administration determined by disease severity and patient characteristics.