Home Medications for Leptospirosis
For mild to moderate leptospirosis suspected in an outpatient setting, start doxycycline 100 mg orally twice daily for 7 days immediately upon clinical suspicion. 1, 2
When to Initiate Home Treatment
Treatment should begin as soon as leptospirosis is clinically suspected based on:
- Exposure history within 2-20 days: Contact with flood water, contaminated fresh water, recreational water sports, occupational exposure to animals (rats, dogs, cattle), or recent flooding 1, 2
- Classic symptom pattern: High fever (≥39°C), severe myalgias (especially calves), headache, and conjunctival suffusion (highly suggestive finding) 1, 2
- Absence of severe disease markers: No jaundice, hemorrhage, respiratory distress, or signs of organ failure 1, 2
Oral Antibiotic Regimen
Doxycycline 100 mg orally twice daily for 7 days is the treatment of choice for mild-to-moderate disease 1, 2. This should be started immediately without waiting for serological confirmation, as serology is often negative in the first week and delay increases mortality 2.
Critical Exclusions for Home Treatment
Patients require immediate hospitalization rather than home treatment if they have:
- Jaundice (indicating Weil's disease) 1, 2
- Signs of hemorrhage or respiratory distress 2
- Inability to tolerate oral medications 2
- Systemic signs suggesting severe infection 1
For hospitalized patients with moderate disease, the same doxycycline regimen can be used, but severe disease requires IV antibiotics (ceftriaxone 2g IV daily or penicillin G 1.5 million units IV every 6 hours for 7 days) 2.
Special Population Considerations
Children under 8 years: Avoid doxycycline due to permanent tooth discoloration risk; use penicillin or ceftriaxone instead, which requires hospitalization 2, 3.
Common Pitfalls to Avoid
- Do not wait for serological confirmation before starting antibiotics—serology is often negative in the first week, and treatment delay increases mortality 2
- Do not mistake for viral hepatitis in patients presenting with fever and jaundice; leptospirosis should remain in the differential 1, 2
- Do not discontinue antibiotics early despite clinical improvement; complete the full 7-day course 1
- Do not use urine for culture—it is not suitable for leptospira isolation 2
Post-Flood Prophylaxis (Not Treatment)
For prevention after flood exposure in high-risk settings, a single dose of doxycycline 200 mg orally provides 76.8% protection, but this is prophylaxis, not treatment of active disease 3. Prophylaxis should be reserved for settings where attack rates exceed 10 cases per 100 person-years 3.