What are the treatment options for Yersinia (Yersinia) infections?

Treatment Options for Yersinia Infections

For Yersinia infections, antibiotics are not usually required for uncomplicated cases, but severe infections should be treated with doxycycline, aminoglycosides, trimethoprim-sulfamethoxazole, or fluoroquinolones, with combination therapy recommended for immunocompromised patients. 1

Treatment Approach by Yersinia Species

Yersinia pestis (Plague)

• First-line treatments for plague include:

  • Streptomycin (15 mg/kg IM every 12 hours) 1, 2
  • Gentamicin (5 mg/kg IV/IM every 24 hours) as a reasonable substitute when streptomycin is unavailable 1
  • Doxycycline (100 mg PO twice daily) 1, 3
  • Fluoroquinolones (e.g., ciprofloxacin 500-750 mg PO twice daily) 1

• Treatment duration should be 10-14 days 1

• For severe infections or bioterrorism scenarios, dual therapy with two distinct classes of antimicrobials is recommended 1

• For pregnant women, gentamicin is preferred over streptomycin due to lower risk of fetal ototoxicity 1

Yersinia enterocolitica

• Uncomplicated infections typically do not require antibiotics 1, 4

• For moderate to severe infections:

  • Fluoroquinolones (e.g., ciprofloxacin) 4, 5
  • Trimethoprim-sulfamethoxazole 4, 5
  • Doxycycline 4

• For severe infections or immunocompromised patients:

  • Third-generation cephalosporins combined with gentamicin 4, 5
  • Fluoroquinolones have shown excellent results with rapid clinical improvement 5, 6

• For septicemia, fluoroquinolones (alone or in combination) have demonstrated 100% cure rates with rapid defervescence within 1-4 days 5

Special Populations

Immunocompromised Patients

• Combination therapy is strongly recommended: 1
  • Doxycycline plus aminoglycoside
  • Trimethoprim-sulfamethoxazole
  • Fluoroquinolones

Pregnant Women

• First-line treatments: 1

  • Ciprofloxacin (400 mg IV every 8 hours or 500 mg PO every 8 hours)
  • Levofloxacin (750 mg every 24 hours IV or PO)
  • Gentamicin (5 mg/kg every 24 hours IV or IM)

• Alternative options: 1

  • Moxifloxacin (400 mg every 24 hours IV or PO)
  • Trimethoprim-sulfamethoxazole (5 mg/kg trimethoprim component every 8 hours IV or PO)

Clinical Pearls and Pitfalls

• Antibiotic susceptibility: Recent studies show Y. pestis isolates remain highly susceptible to recommended antibiotics with no evidence of resistance development 7

• Ineffective treatments for Y. enterocolitica septicemia include aminopenicillins, first-generation cephalosporins, and amoxicillin/clavulanate when used alone 5

• Diagnostic considerations: For Y. pestis, diagnosis can be made by blood cultures and by aspirating lymph nodes for staining and culture 1

• Respiratory isolation is required for patients with bubonic plague until after 48 hours of effective antibiotic therapy to prevent secondary pneumonic plague transmission 1

• Y. enterocolitica infections can mimic appendicitis, especially in school-aged children who may present with mesenteric adenitis 4

• Monitoring for complications is essential, as Y. enterocolitica infections may lead to reactive arthritis, bacteremia, and other serious sequelae 4