Relapsing Fever Treatment & Management

  • Author: Kauser Akhter, MD; Chief Editor: Michael Stuart Bronze, MD   more...
 
Updated: Jan 11, 2012
 

Medical Care

For decades, penicillins and tetracyclines have been the treatment of choice in relapsing fever. In vitro, Borrelia species are also susceptible to cephalosporins, macrolides, and chloramphenicol, although less data are available on these antibiotics.[14, 12] The efficacy of treatment can be demonstrated by noting clearance of spirochetes in the blood, usually occurring within 8 hours of administration of an effective antibiotic.[14, 28]

  • In adults with louse-borne relapsing fever (LBRF), treatment consists of a single dose of tetracycline, doxycycline, or erythromycin. Treatment of tick-borne relapsing fever (TBRF) is the same as that for LBRF, except the treatment duration is 7-10 days.
  • In adults, intravenous therapy with doxycycline, erythromycin, tetracycline, chloramphenicol, or procaine penicillin G should be used when oral therapy is not tolerated.[2]
    • Intravenous chloramphenicol is administered at 500 mg once in LBRF and 500 mg every 6 hours in TBRF.[2] The oral preparation of chloramphenicol is unavailable in the United States.
    • Procaine penicillin G[2] may be administered at a single dose of 600,000 IU in patients with LBRF or 600,000 IU daily in patients with TBRF.[2]
    • In children younger than 8 years and in pregnant or nursing women, erythromycin is preferred.[2]
  • Antibiotic therapy can trigger a Jarisch-Herxheimer reaction, which is described in Complications. The reaction is more common in LBRF (about 80%)[14] but also occurs in TBRF (54% in one series).[14]
  • Meningitis is treated with either intravenous penicillin or ceftriaxone.[4]
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Consultations

  • Consultation with an infectious disease specialist may be helpful.
  • A critical care specialist and/or pulmonologist should be consulted for patients with relapsing fever who are severely ill.
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Activity

Activity is as tolerated in patients with relapsing fever.

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Contributor Information and Disclosures
Author

Kauser Akhter, MD  Clinical Assistant Professor, Department of Internal Medicine, Florida State University College of Medicine; Infectious Diseases Faculty Practice, Orlando Health

Disclosure: Nothing to disclose.

Coauthor(s)

Pierre A Dorsainvil, MD  Medical Director, HIV Specialist, Palm Beach County Main Detention Center; Consulting Staff, Department of Internal Medicine, Division of Infectious Diseases, Lake Ida Medical Center

Disclosure: Nothing to disclose.

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

John M Leedom, MD  Professor Emeritus of Medicine, Keck School of Medicine of the University of Southern California

John M Leedom, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Joseph F John Jr, MD, FACP, FIDSA, FSHEA  Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina College of Medicine; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD  Professor, Stewart G Wolf Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

References

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  6. Barbour AG. Microbiology, pathogenesis, and epidemiology of relapsing fever. UpToDate. Available at http://www.uptodate.com/online/content/topic.do?topicKey=tickflea/11713&selectedTitle=2~15&source=search_result#references. Accessed November 25, 2008.

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Peripheral blood smear in relapsing fever. (Image originally printed in Blevins SM, Greenfield RA, Bronze MS. Blood smear analysis in babesiosis, ehrlichiosis, relapsing fever, malaria, and Chagas disease. Cleve Clin J Med. Jul 2008;75(7):521-30. Reprinted with permission from the Cleveland Clinic.)
 
 
 
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