From the Guidelines
Leptospirosis requires prompt antibiotic treatment upon suspicion, given its non-specific initial investigations and potential for severe disease. The most effective treatment approach is still a topic of debate, but most infectious disease specialists recommend antibiotics, despite a systematic review showing no benefit for antibiotic treatment in established leptospirosis 1. For mild cases, oral antibiotics such as penicillin or tetracycline are thought to be effective during the bacteraemic phase.
Key Considerations
- Treatment should begin as soon as leptospirosis is suspected, without waiting for laboratory confirmation, as early intervention improves outcomes.
- Patients presenting with classical symptoms and signs of Weil's disease, such as jaundice, can become very unwell despite therapy and may require renal or liver support.
- Supportive care, including hydration, fever management, and monitoring for complications like kidney failure or respiratory distress, is essential.
- Prevention involves avoiding contact with potentially contaminated water or soil, especially after flooding, wearing protective clothing when in high-risk environments, and controlling rodent populations.
Mode of Transmission
Leptospira spp. are excreted in the urine of infected animals, in particular rats but also dogs, cattle, and other domestic and wild animals, and humans acquire the infection either through direct contact with urine or with urine-contaminated water 1. Risks include recreational sports, occupational animal or water exposure, and flooding.
Treatment Approach
Given the potential severity of leptospirosis and the limitations of current evidence, a prompt and empiric antibiotic treatment approach is recommended, with the choice of antibiotic depending on the severity of the disease and the patient's clinical presentation.
From the Research
Overview of Leptospirosis
- Leptospirosis is a parasitic disease transmitted by animals, which can result in hospitalization and has a mortality rate of about 5% 2.
- The disease is caused by pathogenic Leptospira species and is primarily transmitted through contact with animals or exposure to contaminated water or soil 3, 4.
Treatment of Leptospirosis
- Antibiotics are commonly prescribed for the management of leptospirosis, but there is insufficient evidence to determine their effectiveness or to recommend antibiotic use as a standard practice 2, 4, 5.
- Penicillin is widely used for treating leptospirosis, and some studies suggest that it may cause more good than harm 2.
- Other antibiotics such as doxycycline and ceftriaxone have also been used to treat leptospirosis, but the evidence is limited and inconclusive 6, 3, 4.
Effectiveness of Antibiotics
- The evidence is very uncertain about the effect of antibiotics on all-cause mortality, serious adverse events, or adverse events considered non-serious 4.
- Some studies suggest that antibiotics may reduce the duration of clinical illness by two to four days, but this result is not statistically significant 5.
- The choice of antibiotic, such as penicillin, doxycycline, or cephalosporin, does not seem to impact mortality or duration of fever 5.
Challenges in Diagnosis and Treatment
- Early diagnosis of leptospirosis can be challenging due to nonspecific symptoms, which may lead to delay in recommended intravenous antibiotic treatment 6.
- The lack of definitive rigorous data from randomized trials to support the use of antibiotics for treating leptospirosis infection is a significant limitation 4.
- Further clinical research is needed to include broader panels of therapy tested against placebo to determine the effectiveness of antibiotics in treating leptospirosis 5.