What is the treatment for Leptospirosis?

Treatment for Leptospirosis

Treatment for leptospirosis should be started as soon as possible with antibiotics such as doxycycline or penicillin, without waiting for laboratory confirmation, especially in severe cases. 1

Clinical Classification

• Leptospirosis is classified into two main clinical forms according to the World Health Organization 1:
  • Mild to moderate form (most common) - flu-like symptoms
  • Severe form (Weil's disease) - characterized by hemorrhage, jaundice, and hepato-renal failure (occurs in 5-10% of infected individuals)

Diagnosis

• Clinical diagnosis is crucial as laboratory confirmation often takes too long 2
• Key diagnostic features include:
  • Fever with chills (usually ≥39°C) 1
  • Diffuse myalgias, especially in the calves 1, 3
  • Headache 1, 3
  • Conjunctival suffusion (highly suggestive sign) 1, 3
  • Jaundice (in severe cases) 1, 3
• Laboratory findings may include:
  • Proteinuria and hematuria 1
  • Leukocytosis with polymorphonuclear cells 1
  • Thrombocytopenia (platelets <140 G/L) in 65.5% of patients 3
  • Elevated bilirubin with mild elevation of transaminases 1
  • Renal function abnormalities 1

Treatment Protocol

Mild to Moderate Leptospirosis

• Start antibiotics as soon as possible 1, 4
• Recommended antibiotics:
  • Doxycycline (first-line) 1
  • Penicillin as an alternative 1

Severe Leptospirosis (Weil's Disease)

• Immediate antibiotic treatment without waiting for confirmation 1
• Hospitalization with close monitoring 3
• Recommended antibiotics:
  • Penicillin (high doses) 1, 4
  • Doxycycline as an alternative 1
• Supportive therapy is essential and should include 4:
  • Fluid and electrolyte management
  • Renal support (dialysis if needed) 3, 5
  • Respiratory support if ARDS develops 3

Prognostic Factors

• Poor prognostic indicators independently associated with severe disease:
  • Clinical jaundice 3
  • Cardiac damage (clinical or ECG changes) 3
• Other factors associated with increased mortality:
  • History of alcoholism 5
  • Presence of chronic liver disease 5
  • Acute renal failure requiring dialysis 5
  • Need for intensive care 5

Treatment Duration and Considerations

• Antimicrobial therapy should be started early in the disease course, ideally before the fourth day of illness 2
• For penicillin, cephems, tetracyclines, and macrolides, long-term therapy with large doses may be required from early disease stage until antibody appearance 4
• Combination antibiotic therapy may be associated with lower mortality rates in severe cases 5

Prevention

• Doxycycline has been shown effective for prophylaxis in high-risk exposure situations 6
• Number needed to treat: 24 (95% CI: 17 to 43) 6
• Adverse effects occur in approximately 3% of patients receiving prophylactic doxycycline 6

Common Pitfalls and Caveats

• Delayed diagnosis due to non-specific presentation resembling other febrile illnesses 2
• Waiting for laboratory confirmation before starting treatment (treatment should begin based on clinical suspicion) 1, 2
• Underestimating severity - monitor closely for progression to multiorgan failure 3, 5
• Inadequate antibiotic dosing - higher doses may be required for severe disease 4
• Failure to recognize and address complications like renal failure, respiratory distress, and cardiac involvement 3