What is the treatment for Leptospirosis?

Treatment of Leptospirosis

For mild to moderate leptospirosis, start antibiotics (penicillin or doxycycline) as soon as possible based on clinical suspicion; for severe leptospirosis (Weil's disease), initiate antibiotics within the first hour without waiting for laboratory confirmation. 1

Clinical Classification and Recognition

Leptospirosis presents in two distinct forms that guide treatment intensity 1:

• Mild to moderate form: Flu-like symptoms including high fever (≥39°C), diffuse myalgias (especially calves), headache, and conjunctival suffusion—this is the most common presentation 1
• Severe form (Weil's disease): Characterized by hemorrhage, jaundice, and hepato-renal failure, occurring in approximately 5-10% of cases 1

Key Clinical Indicators for Severe Disease

Two factors independently predict progression to severe leptospirosis and should trigger immediate aggressive management 2:

• Clinical jaundice (p=0.005) 2
• Cardiac involvement seen clinically or on ECG (p<0.02) 2

Additional warning signs include thrombocytopenia (<140 G/L in 65.5% of cases), proteinuria, hematuria, elevated bilirubin with mild transaminase elevation, and renal dysfunction 1, 2

Treatment Approach by Severity

Mild to Moderate Leptospirosis

Antibiotic options 1:

• Doxycycline (preferred for outpatient management)
• Penicillin (alternative option)
• Standard treatment duration: 7 days 1
• May extend to 10 days in patients with slow clinical response 1

Critical timing consideration: Treatment initiated after 4 days of symptoms may be less effective, emphasizing the need for early empiric therapy based on clinical suspicion 1, 3

Severe Leptospirosis (Weil's Disease)

Immediate management priorities 1:

1. Start antibiotics within the first hour of recognizing severe sepsis or septic shock—do not wait for laboratory confirmation, as delays increase mortality 1
2. Antibiotic selection: Penicillin or tetracyclines (doxycycline) 1
3. Duration: 7 days standard, extend to 10 days if slow clinical response 1
4. Daily reassessment of antimicrobial regimen for potential de-escalation 1

Supportive care requirements 1:

• Fluid resuscitation targeting systolic blood pressure >90 mmHg in adults with adequate tissue perfusion as the endpoint 1
• Continuous monitoring with frequent clinical examinations—septic patients should never be left alone 1
• Watch for fluid overload: Monitor for crepitations indicating impaired cardiac function during resuscitation 1
• ICU admission for persistent or worsening tissue hypoperfusion despite initial fluid resuscitation 1
• Source control measures within 12 hours if applicable 1

Diagnostic Confirmation

While treatment should not be delayed for confirmation, understanding diagnostic methods helps guide management 1:

• Serology: IgM titers >1:320 are suggestive; titers of 1:80-1:160 consistent with early infection 1
• Blood cultures: Most useful if obtained within first 5 days before antibiotics 1
• Convalescent serology: >10 days after symptom onset can confirm diagnosis 1
• NAAT testing: 1-2 hour turnaround time when available 1

Common Pitfalls to Avoid

Do not mistake leptospirosis for viral hepatitis in patients presenting with fever and jaundice—this is a common misdiagnosis that delays appropriate antibiotic therapy 1

Do not discontinue antibiotics early even with clinical improvement—complete the full 7-10 day course 1

Do not delay treatment waiting for laboratory confirmation in suspected severe cases—clinical diagnosis based on epidemiological exposure (contaminated water, animal contact, occupational risk) plus compatible symptoms is sufficient to initiate therapy 1, 3

Prevention Context

For high-risk exposures (floods, occupational water contact), doxycycline 200 mg single dose provides 76.8% protective efficacy against infection and 86.3% against clinical disease 4. However, tetracyclines are contraindicated in children under 8 years due to permanent tooth discoloration risk 4.