Tularemia Treatment & Management

  • Author: Kerry O Cleveland, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Jan 12, 2012
 

Medical Care

  • Medical care in tularemia is directed primarily toward antibiotic eradication of F tularensis. Provide symptomatic and supportive care for accompanying conditions (eg, osteomyelitis, pericarditis, peritonitis) as clinically indicated.
  • Streptomycin is considered the drug of choice (DOC). Less experience has been reported with other aminoglycosides, but gentamicin and amikacin are also effective.
  • Chloramphenicol and tetracycline are clinically useful; however, relapse rates of up to 50% are reported when these agents are used.
  • Case reports indicate a potential role for erythromycin or fluoroquinolones (ciprofloxacin, levofloxacin); however, clinical experience and in vitro data supporting their use are limited.
  • In vitro susceptibility data support the possible role of third-generation cephalosporins (cefotaxime, ceftriaxone) and rifampin. However, failures occur with attempted third-generation therapy, and these agents should not be used for known or suspected tularemia.
  • F tularensis is naturally resistant to penicillins and first-generation cephalosporins.
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Surgical Care

  • Surgical care is not needed in tularemia management unless an ulcerative lesion develops a superinfection and requires debridement or a lymph node requires drainage.
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Consultations

  • Consider consultation with an infectious diseases specialist to help determine the diagnosis and treatment plan.
  • In patients with pneumonia or ARDS, assistance from a pulmonologist may be necessary.
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Diet

  • No special diet is required in patients with tularemia.
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Activity

  • Activity should not be restricted in patients with tularemia.
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Contributor Information and Disclosures
Author

Kerry O Cleveland, MD  Associate Professor of Medicine, University of Tennessee College of Medicine; Consulting Staff, Department of Internal Medicine, Division of Infectious Diseases, Methodist Healthcare of Memphis

Kerry O Cleveland, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America, and Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Coauthor(s)

Michael Gelfand, MD, FACP  Chief, Professor, Department of Internal Medicine, Division of Infectious Diseases, Methodist Healthcare of Memphis, University of Tennessee

Michael Gelfand, MD, FACP is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, and Southern Medical Association

Disclosure: Nothing to disclose.

Gregory J Raugi, MD, PhD  Professor, Department of Internal Medicine, Division of Dermatology, University of Washington at Seattle School of Medicine; Chief, Dermatology Section, Primary and Specialty Care Service, Veterans Administration Medical Center of Seattle

Gregory J Raugi, MD, PhD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Mark R Wallace, MD, FACP, FIDSA  Clinical Professor of Medicine, Florida State University College of Medicine; Head of Infectious Disease Fellowship Program, Orlando Regional Medical Center

Mark R Wallace, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Tropical Medicine and Hygiene, and Infectious Diseases Society of America

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

Richard B Brown, MD, FACP  Chief, Division of Infectious Diseases, Baystate Medical Center; Professor, Department of Internal Medicine, Tufts University School of Medicine

Richard B Brown, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, and Massachusetts Medical Society

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

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.

References

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Eschar on thumb and under thumbnail at the site of a rabbit bite in a patient with tularemia.
Axillary bubo in a patient with tularemia.
Ulceroglandular type of tularemia on the hand. Courtesy of Dr Hon Pak.
Ulceroglandular tularemia on an extremity. Courtesy of Dr Hon Pak.
Ulceroglandular type of tularemia on the hand. Courtesy of Dr Hon Pak.
 
 
 
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