What is the treatment for Leptospirosis?

Treatment of Leptospirosis

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

Clinical Classification

• Leptospirosis is classified into two main clinical forms 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 tests often take too long, and treatment should begin early 2
• Key clinical findings suggesting leptospirosis include:
  • Fever with chills (most common presentation) 1, 3
  • Diffuse myalgias, especially in calves 1, 3
  • Headache 1
  • Conjunctival suffusion (a 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
  • Alterations in renal function tests 1

Treatment Recommendations

For Mild to Moderate Leptospirosis:

• Start antibiotics as soon as possible 1
• Recommended antibiotics:
  • Doxycycline 1, 4
  • Penicillin 1, 4

For Severe Leptospirosis (Weil's disease):

• Initiate treatment immediately without waiting for confirmation 1
• Hospitalization is required, often in intensive care 3
• Intravenous antibiotics:
  • Penicillin (high doses) 1, 4
  • Cephalosporins may also be effective 4
• Supportive care is crucial:
  • Renal replacement therapy if needed 3, 5
  • Respiratory support for ARDS cases 3
  • Correction of coagulopathies 3

Prognostic Factors

• Poor prognostic factors independently associated with severe disease:
  • Clinical jaundice 3
  • Cardiac damage (clinical or ECG evidence) 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

Prevention

• For high-risk individuals in endemic areas, prophylactic doxycycline may be effective 6
• Number needed to treat: 24 (95% CI 17 to 43) 6
• Adverse effects occur in approximately 3% of patients taking prophylactic doxycycline 6
• Avoid contact with urine from infected animals and contaminated water 1
• Take precautions during water recreational activities, occupational exposure to animals or water, and during floods 1

Treatment Duration and Monitoring

• Long-term therapy with large doses may be required from early disease stage until antibody appearance 4
• Monitor for:
  • Renal function deterioration 1, 3
  • Development of jaundice (indicates severe disease) 3
  • Cardiac complications 3
  • Respiratory distress 3

Special Considerations

• Combination antibiotic therapy may be associated with lower mortality rates in severe cases 5
• Early treatment (before the fourth day of illness) is crucial for limiting life-threatening complications 2
• Blood cultures should be taken in the first 5 days before antibiotics if possible 1