- Author: Sandra G Gompf, MD, FACP, FIDSA; Chief Editor: Michael Stuart Bronze, MD more...
Treatment for leptospirosis consists of empiric antibiotic therapy. In general, antibiotic therapy should be effective against leptospirosis and against the other pathogens considered in the differential diagnoses. If renal failure ensues, corticosteroids may be considered. Additional supportive care may include inotropic agents, diuretics, or ophthalmic drops. Currently, no human vaccine against leptospirosis is available.
For severe leptospirosis, intravenous penicillin G has long been considered the drug of choice. Doxycycline is used for the treatment of mild leptospirosis. Ampicillin or amoxicillin are alternatives for the treatment of mild leptospirosis. Erythromycin is the therapy of choice in pregnant patients who are allergic to penicillin. Third-generation cephalosporins have become widely used for intravenous antibiotic treatment in patients with severe leptospirosis.
Intravenous penicillin is first-line antibiotic therapy for severe leptospirosis. Penicillin interferes with synthesis of cell wall mucopeptide during active multiplication, resulting in bactericidal activity against susceptible microorganisms.
Doxycycline inhibits protein synthesis, and thus bacterial growth, by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria. Excretion is hepatobiliary and renal.
Ampicillin is a second-line agent or for patients younger than 8 years of age, in whom doxycycline is contraindicated. This agent interferes with synthesis of cell-wall mucopeptides during active multiplication, resulting in bactericidal activity. Excretion is primarily renal, although some ampicillin is metabolized by the liver.
Amoxicillin is a second-line agent or for patients younger than 8 years of age, in whom doxycycline is contraindicated. This agent interferes with synthesis of cell wall mucopeptides during active multiplication, resulting in bactericidal activity against susceptible bacteria.
Erythromycin inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. In pregnant patients who are allergic to penicillin, erythromycin is the therapy of choice.
A third-generation cephalosporin with broad gram-negative spectrum, cefotaxime has lower efficacy against gram-positive organisms and higher efficacy against resistant organisms. This agent arrests bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins, which in turn inhibits bacterial growth.
Ceftriaxone is a third-generation cephalosporin with broad-spectrum, gram-negative activity. It has lower efficacy against gram-positive organisms and higher efficacy against resistant organisms.
Ceftriaxone exerts its bactericidal effect by interfering with the synthesis of peptidoglycan, a major structural component of bacterial cell walls. Bacteria eventually lyse owing to the ongoing activity of cell wall autolytic enzymes while cell wall assembly is arrested.
Ceftriaxone is highly stable in presence of beta-lactamases, both penicillinase and cephalosporinase, produced by gram-negative and gram-positive bacteria. Approximately 33-67% of the dose is excreted unchanged in urine; the remainder is secreted in bile and ultimately in feces as microbiologically inactive compounds.
This agent reversibly binds to human plasma proteins. Binding has been reported to decrease with increasing plasma concentrations of the drug, from 95% bound at plasma concentrations < 25 mcg/mL to 85% bound at 300 mcg/mL.
In patients with leptospirosis, corticosteroids are indicated to improve renal failure outcome.
Methylprednisolone decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing increased capillary permeability. High-dose pulsed methylprednisolone (30 mg/kg/d, not to exceed 1500 mg) has been used successfully to treat patients with leptospiral renal failure without dialysis.
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