eMedicine Specialties > Dermatology > Bacterial Infections

Rocky Mountain Spotted Fever: Treatment & Medication

Author: Nicole L Lacz, MD, Chief Resident, Department of Radiology, St Barnabas Medical Center
Coauthor(s): Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School; Rajendra Kapila, MD, MBBS, Professor of Medicine, Department of Medicine, UMDNJ, New Jersey Medical School
Contributor Information and Disclosures

Updated: Jun 26, 2009

Treatment

Medical Care

  • Any patient presenting with fever and a rash must be considered for hospitalization and antimicrobial therapy.
  • Antibiotics and supportive care must be initiated for any patient suspected to have Rocky Mountain spotted fever (RMSF), even in the absence of diagnostic testing.

Consultations

  • Rocky Mountain spotted fever (RMSF) is a nationally reportable disease.
  • Specialties to consider for evaluation of a patient include a dermatologist, an infectious disease specialist, a neurologist, and an ophthalmologist.

Medication

The mainstay of treatment of Rocky Mountain spotted fever (RMSF) is antimicrobial therapy, which must be initiated at first suspicion of the illness. Doxycycline is the antibiotic agent of choice for treating adults and even children because of its effectiveness, broad margin of safety, and convenient dosing schedule.10 As many as 5 courses of doxycycline can be used for cases of reinfection, with minimal risk of dental staining.10 Chloramphenicol is the medication of choice in pregnant women, even though gray baby syndrome is a risk.11,12

Antibiotics

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of this clinical setting.


Doxycycline (Bio-Tab, Doryx, Vibramycin)

DOC for RMSF in adults and children. Inhibits protein synthesis and, thus, bacterial growth by binding to 30S and, possibly, 50S ribosomal subunits of susceptible bacteria.

Adult

100 mg bid for 7 d and for at least 72 h after defervescence; give PO if outpatient and IV if inpatient

Pediatric

2-5 mg/kg/d divided bid for 7 d and for at least 72 h after defervescence; give PO if outpatient and IV if inpatient; not to exceed 200 mg/d

Bioavailability decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; tetracyclines can increase hypoprothrombinemic effects of anticoagulants; tetracyclines can decrease effects of oral contraceptives, causing breakthrough bleeding and increased risk of pregnancy

Documented hypersensitivity; severe hepatic dysfunction

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment; consider drug serum level determinations in prolonged therapy; tetracycline use during tooth development (last one half of pregnancy through age 8 y) can cause permanent discoloration of teeth; Fanconilike syndrome may occur with outdated tetracyclines


Chloramphenicol (Chloromycetin)

Drug of choice for RMSF in pregnant women and alternative choice for patients who are allergic to doxycycline. Binds to 50S bacterial ribosomal subunits and inhibits bacterial growth by inhibiting protein synthesis.

Adult

Pregnant patients: 50-75 mg/kg/d IV divided qid for 7 d and for at least 48 h after defervescence
Patients allergic to doxycycline: 500 mg IV divided qid for 7 d and for at least 72 h after defervescence

Pediatric

50-100 mg/kg/d IV qid for 7 d and for at least 48 h after defervescence

Administered concurrently with barbiturates, serum levels may decrease while barbiturate levels may increase causing toxicity; manifestations of hypoglycemia may occur with sulfonylureas; rifampin may reduce serum levels, presumably through hepatic enzyme induction; may increase effects of anticoagulants; may increase serum hydantoin levels, possibly resulting in toxicity; chloramphenicol levels may be increased or decreased

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Use only for indicated infections or as prophylaxis for bacterial infections; serious and fatal blood dyscrasias (eg, aplastic anemia, hypoplastic anemia, thrombocytopenia, granulocytopenia) can occur; evaluate baseline and perform periodic blood studies approximately every 2 d while on therapy; discontinue upon appearance of reticulocytopenia, leukopenia, thrombocytopenia, anemia, or findings attributable to chloramphenicol; adjust dose in liver or kidney dysfunction; caution in pregnancy at term or during labor because of potential toxic effects on fetus (gray baby syndrome)

More on Rocky Mountain Spotted Fever

Overview: Rocky Mountain Spotted Fever
Differential Diagnoses & Workup: Rocky Mountain Spotted Fever
Treatment & Medication: Rocky Mountain Spotted Fever
Follow-up: Rocky Mountain Spotted Fever
Multimedia: Rocky Mountain Spotted Fever
References
Further Reading
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Keywords

Rocky Mountain spotted fever, RMSF, Rickettsia rickettsii, R rickettsii, tick-borne diseases, rickettsioses, Amblyomma cajennense, A cajennense, Rhipicephalus sanguineous, R sanguineous, Dermacentor andersoni, D andersoni, tick fever, spotted fever

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Contributor Information and Disclosures

Author

Nicole L Lacz, MD, Chief Resident, Department of Radiology, St Barnabas Medical Center
Nicole L Lacz, MD is a member of the following medical societies: Alpha Omega Alpha, Phi Beta Kappa, and Sigma Xi
Disclosure: Nothing to disclose.

Coauthor(s)

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

Rajendra Kapila, MD, MBBS, Professor of Medicine, Department of Medicine, UMDNJ, New Jersey Medical School
Rajendra Kapila, MD, MBBS is a member of the following medical societies: American College of Physicians, American Medical Association, Infectious Diseases Society of America, and Infectious Diseases Society of New Jersey
Disclosure: Nothing to disclose.

Medical Editor

Noah S Scheinfeld, MD, JD, FAAD, Assistant Clinical Professor, Department of Dermatology, Columbia University; Consulting Staff, Department of Dermatology, St Luke's Roosevelt Hospital Center, Beth Israel Medical Center, New York Eye and Ear Infirmary; Private Practice
Noah S Scheinfeld, MD, JD, FAAD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Optigenex Consulting fee Independent contractor

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Jeffrey Meffert, MD, Assistant Clinical Professor of Dermatology, University of Texas Health Science Center-San Antonio
Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society
Disclosure: Nothing to disclose.

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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