What are the recommended home medications for a patient being discharged after hospitalization for leptospirosis?

Home Medications for Leptospirosis After Hospital Discharge

For patients being discharged after hospitalization for leptospirosis, complete a full 7-day course of antibiotics (doxycycline 100 mg twice daily or amoxicillin 500-1000 mg three times daily), counting from the day antibiotics were initiated in the hospital, not from the discharge date. 1, 2

Antibiotic Continuation Strategy

Primary Recommendation: Doxycycline

• Doxycycline 100 mg orally twice daily to complete a total 7-day course (including inpatient days) is the preferred home medication 1, 2, 3
• This regimen reduces illness duration by approximately 2 days and favorably affects fever, malaise, headache, and myalgias 2
• Doxycycline prevents leptospiruria (bacterial shedding in urine) in 95% of cases compared to 60% with placebo 2, 4

Alternative Option: Penicillin-Based Therapy

• Amoxicillin 500-1000 mg orally three times daily can be used as an alternative if doxycycline is contraindicated 1, 3
• Penicillin has historically been considered the treatment of choice and demonstrates efficacy in reducing mortality and hospital stay 3, 4

Critical Contraindication

• Never prescribe doxycycline to children under 8 years of age due to risk of permanent tooth discoloration and enamel hypoplasia 5
• For pediatric patients under 8 years, use amoxicillin instead 5

Treatment Duration Algorithm

Calculate total antibiotic days from hospital initiation:

• If patient received antibiotics for 3 days in hospital → prescribe 4 additional days at discharge 1, 2
• If patient received antibiotics for 5 days in hospital → prescribe 2 additional days at discharge 1, 2
• Standard total duration: 7 days for uncomplicated leptospirosis 1, 2, 3

Extend to 10 days ONLY if:

• Slow clinical response or persistent fever beyond 72 hours of antibiotic initiation 1
• Severe disease with multi-organ involvement (Weil's disease) 1

Common Pitfalls to Avoid

Do Not Stop Antibiotics Early

• Complete the full 7-day course even if symptoms resolve 1, 2
• Early discontinuation increases risk of relapse and persistent leptospiruria 2, 4

Do Not Prescribe Prophylactic Antibiotics to Household Contacts

• Leptospirosis is not transmitted person-to-person 5
• Prophylaxis is only indicated for high-risk occupational exposures with attack rates >10 per 100 person-years 5

Avoid Macrolide Monotherapy

• Azithromycin shows promise for mild disease but lacks robust evidence for post-hospitalization cases 3
• Reserve azithromycin only for patients with documented severe penicillin and tetracycline allergies 3

Supportive Care Medications

No routine supportive medications are required for uncomplicated cases 1, 6

Symptomatic management may include:

• Acetaminophen or NSAIDs for fever and myalgias (avoid aspirin due to potential bleeding risk in severe cases) 1
• Antiemetics if nausea persists after hospital discharge 1

Corticosteroids are NOT recommended for routine discharge unless specifically initiated for severe pulmonary hemorrhage during hospitalization 6

Follow-Up Instructions

Clinical reassessment at 48-72 hours post-discharge:

• Fever should resolve within 2-3 days of antibiotic initiation 1
• If fever persists beyond 72 hours, consider alternative diagnosis or complications 1

Return precautions:

• Worsening jaundice, decreased urine output, or respiratory symptoms warrant immediate re-evaluation 1
• These may indicate progression to Weil's disease despite treatment 1