eMedicine Specialties > Infectious Diseases > Bacterial Infections
Pseudotuberculosis (Yersinia): Treatment & Medication
Updated: Sep 8, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Treatment
Medical Care
Y pseudotuberculosis infection is often self-limited. However, more toxic presentations, including septic syndromes, severe dehydration, or other obscured diagnostic issues, may warrant hospitalization. General supportive care of such patients is needed.
Surgical Care
Exploratory laparotomy may be warranted in patients with complications such as severe abdominal pain, including acute abdominal presentations, peritoneal findings, or, uncommonly, intussusception. However, this intervention is not common.
Consultations
Consultation with an infectious diseases specialist may be helpful. Gastroenterologists or surgeons may be needed if invasive diagnostic or therapeutic interventions are warranted. For unusual presentations, such as rheumatologic, dermatologic, or ocular complications, the respective consultations may be helpful, primarily for assisting with considering Y pseudotuberculosis infection in the differential diagnoses.
Diet
No special diet is recommended; however, given the enteric nature of the symptoms and associated abdominal pain, diarrhea, fever, and anorexia that accompany such illness, it may be prudent to maintain the patient on a nothing–by-mouth (NPO) status through the diagnostic phase of the disease and to push fluids to prevent dehydration as needed, often intravenously. As the enteric syndromes resolve, the patient’s natural appetite will improve, and, accordingly, it is appropriate to ensure adequate caloric intake.
Activity
Bedrest through the acute illness is recommended. Activity as tolerated can be resumed once the enteric and systemic symptoms resolve.
Medication
In most cases, Y pseudotuberculosis infections do not require therapy with antimicrobials. However, in younger or immunosuppressed patients who are critically ill, beta-lactam antibiotic therapy may be prudent. Antibiotic therapy (initially intravenous) is warranted to treat the septic form of Y pseudotuberculosis infection. Guidance by in vitro testing may be helpful; initial empiric therapy should include an aminopenicillin (eg, ampicillin with or without a beta-lactamase inhibitor) and, ideally, an aminoglycoside.
Ampicillin may shorten the duration of culture positivity in patients infected with the Kawasaki-like variant of Y pseudotuberculosis infection; however, ampicillin probably will not alter the clinical situation. Combination therapy is not essential in most cases. The aminoglycoside streptomycin has been used to treat Yersinia infections, although gentamicin and tobramycin are considered appropriate. Third-generation cephalosporins have also been used. Chloramphenicol may be used in patients with allergies to penicillin or aminoglycoside.
Antimicrobials
Therapy must be comprehensive and cover all likely pathogens in the context of the clinical setting.
Ampicillin (Marcillin, Omnipen)
Broad-spectrum antibiotic that can be administered in IV form for septic presentations. Bactericidal activity against susceptible organisms. Alternative to amoxicillin when unable to take medication PO. Because of the resistance of Y enterocolitica to ampicillin and its greater prevalence, this agent would not be a good choice for empiric therapy in a clinical situation where either organism could be present.
Adult
500 mg PO q6h
1-2 g IV q4h
Sepsis/meningitis: 150-250 mg/kg/d PO/IV divided q3-4h
Pediatric
<7 days:
<2000 g: 25 mg/kg IV/IM q12h; for meningitis, 50 mg/kg IV/IM q12h
>2000 g: 25 mg/kg IV/IM q8h; for meningitis, 50 mg/kg IV/IM q8h
>7 days:
<1200 g: 25 mg/kg IV/IM q12h; for meningitis, 50 mg/kg IV/IM q12h
1200-2000 g: 25 mg/kg IV/IM q8h; for meningitis, 50 mg/kg IV/IM q8h
>2000 g: 25 mg/kg IV/IM q6h; for meningitis, 50 mg/kg IV/IM q6h
Infants and children: 100-400 mg/kg/d IV/IM divided q4-6h; for meningitis, 200 mg/kg/d IV/IM divided q4-6h; not to exceed 12 g/d
Children: 50-100 mg/kg/d PO divided q6h; not to exceed 2-3 g/d
Probenecid and disulfiram elevate ampicillin levels; allopurinol decreases ampicillin effects and has additive effects on ampicillin rash; may decrease effects of oral contraceptives
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Cross-allergenicity with beta-lactam drugs does exist but is unlikely
Patients with concurrent infectious mononucleosis have a higher likelihood of developing a skin rash while taking ampicillin; it is important to differentiate this rash from a true hypersensitivity reaction
Within the first 1-2 weeks of therapy, pediatric patients may have a <10% risk of developing a generalized, erythematous rash; the rash is characterized by a distribution involving knees and elbows—often intensely at pressure sites
Adjust dose in renal failure
Streptomycin sulfate
Especially recommended in combination therapy with broad-spectrum antibiotics (eg, ampicillin, piperacillin) for septic presentations and/or immunosuppressed hosts.
Recommended when less potentially hazardous therapeutic agents are ineffective or contraindicated.
Adult
1 g IM qd; daily dosing likely more appropriate than intermittent dosing
2 times/wk dosing: 15 mg/kg/d IM; not to exceed 1 g/d
3 times/wk dosing: 25-30 mg/kg/d IM; not to exceed 1.5 g/d
Pediatric
Not established
Nephrotoxicity may be increased with aminoglycosides, cephalosporins, penicillins, amphotericin B, and loop diuretics
Documented hypersensitivity; non–dialysis-dependent renal insufficiency
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Narrow therapeutic index; not intended for long-term therapy; caution in renal failure not on dialysis, myasthenia gravis, hypocalcemia, and conditions that depress neuromuscular transmission
Tobramycin (Nebcin)
Aminoglycoside antibiotic for gram-negative coverage. Used in combination with both an agent against gram-positive organisms and one that covers anaerobes.
Adult
Life-threatening infections: 5 mg/kg/d IV q24h, reduce to 3 mg/kg/d as soon as clinically indicated; not to exceed 5 mg/kg/d; adjust dose based on CrCl and changes in volume of distribution
Pediatric
Not established
Increases effects of neuromuscular blockers and potentiates effect of extended spectrum penicillins; concurrent administration with amphotericin B, cephalosporins, and loop diuretics increases risk of nephrotoxicity
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Caution in renal impairment, preexisting auditory or vestibular impairment, and in patients with neuromuscular disorders; aminoglycosides are associated with nephrotoxicity and ototoxicity
Gentamicin (Garamycin)
Aminoglycoside antibiotic for gram-negative coverage. Used in combination with both an agent against gram-positive organisms and one that covers anaerobes.
Adult
Serious infections and normal renal function: 3 mg/kg/d IV q8h
Loading dose: 1-2.5 mg/kg IV q8h
Maintenance dose: 1-1.5 mg/kg IV q8h
Pediatric
Not established
Coadministration with other aminoglycosides, cephalosporins, penicillins, and amphotericin B may increase nephrotoxicity; enhances effects of neuromuscular blocking agents thus prolonged respiratory depression may occur; coadministration with loop diuretics may increase auditory toxicity; possible irreversible hearing loss of varying degrees may occur (monitor regularly)
Documented hypersensitivity; non–dialysis-dependent renal insufficiency
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
Narrow therapeutic index (not intended for long-term therapy); caution in renal failure (not on dialysis), myasthenia gravis, hypocalcemia, and conditions that depress neuromuscular transmission; adjust dose in renal impairment
Chloramphenicol (Chloromycetin)
Binds to 50 S bacterial-ribosomal subunits and inhibits bacterial growth by inhibiting protein synthesis. Effective against gram-negative and gram-positive bacteria.
Adult
500 mg PO/IV q6h for 10 d; not to exceed 4 g/d
Pediatric
Not established
Concurrently with barbiturates, chloramphenicol 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
Documented hypersensitivity
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 (aplastic anemia, hypoplastic anemia, thrombocytopenia, granulocytopenia) can occur; evaluate baseline and perform periodic blood studies approximately every 2 d while in 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 syndrome)
Piperacillin (Pipracil)
Inhibits biosynthesis of cell wall mucopeptides and stage of active multiplication. Has antipseudomonal activity.
Adult
Serious infection: 4 g IV q8h; not to exceed 24 g/d
Pediatric
Not established
At high concentrations, piperacillin may physically inactivate aminoglycosides; probenecid may increase levels; coadministration with aminoglycosides has synergistic effects
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Caution in renal impairment or history of seizures
Cefotaxime (Claforan)
Third-generation cephalosporin with gram-negative spectrum. Lower efficacy against gram-positive organisms.
For septicemia caused by susceptible organisms. Arrests bacterial cell wall synthesis, which, in turn, inhibits bacterial growth.
Adult
Moderate-to-severe infections: 2 g IV q6h
Life-threatening infections: 1-2 g IV/IM q4h
Pediatric
Not established
Probenecid may increase levels; coadministration with furosemide and aminoglycosides may increase nephrotoxicity
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in severe renal impairment; associated with severe colitis
More on Pseudotuberculosis (Yersinia) |
| Overview: Pseudotuberculosis (Yersinia) |
| Differential Diagnoses & Workup: Pseudotuberculosis (Yersinia) |
 Treatment & Medication: Pseudotuberculosis (Yersinia) |
| Follow-up: Pseudotuberculosis (Yersinia) |
| References |
| Further Reading |
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Further Reading
The reader may find the following texts useful:
The Genus Yersinia: From Genomics to Function
Series: Advances in Experimental Medicine and Biology, Vol. 603
Perry, Robert D.; Fetherston, Jacqueline D. (Eds.)
2007, XXIV, 432 p. 242 illus., 2 in color., Hardcover
ISBN: 978-0-387-72123-1
Yersinia enterocolitica and Yersinia pseudotuberculosis Infections (Enteritis and Other Illnesses) In: Pickering LK, Baker CJ, Long SS, McMillan JA, eds. Red Book: 2006 Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2006:[732-4]
Keywords
Yersinia pseudotuberculosis, Y pseudotuberculosis, Y pseudotuberculosis gastroenteritis, Far East scarlet-like fever, FESLF, scarlatinoid fever, scarlet fever, Izumi fever, YPM, YPMa, YPMb, YPMc, Kawasaki disease, Pasteurella pseudotuberculosis, P pseudotuberculosis, Shigella pseudotuberculosis, S pseudotuberculosis, Bacillus pseudotuberculosis, B pseudotuberculosis, Yersinia infections, Yersinia mesenteric adenitis
