eMedicine Specialties > Infectious Diseases > Special Topics

Chronic Fatigue Syndrome: Treatment & Medication

Author: 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
Contributor Information and Disclosures

Updated: Oct 19, 2009

Treatment

Medical Care

  • Because most cases of chronic fatigue syndrome (CFS) may be based on a viral infection, no uniformly effective therapy exists for CFS.
  • In patients with elevated C pneumoniae levels, particularly increased IgM titers, antichlamydial therapy may be effective.

Consultations

  • Infectious disease specialists should perform a history and physical examination on patients with possible CFS.

Diet

  • No special diet or vitamin supplements are effective.

Activity

  • Rest (as needed)
  • Moderate activity
  • No exercise

Medication

Trials of antiviral agents have been ineffective in relieving the symptoms of chronic fatigue syndrome (CFS). Various medications have been shown to be ineffective, including steroids, liver extract (eg, Kutapressin), chelation therapy, intravenous vitamin therapy, vitamin B-12 therapy, and intravenous or oral vitamin/mineral supplements. Antidepressants have little role in CFS.

Antibiotics

These agents are used in patients with elevated IgM C pneumoniae titers.


Doxycycline (Vibramycin, Doryx)

Second-generation tetracycline. Much more active than tetracycline against many pathogens. Different adverse-effect profile and pharmacokinetics compared to tetracycline. Inhibits bacterial growth, possibly blocking dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

Adult

100-200 mg PO bid q12h

Pediatric

>12 years: Administer as in adults

Documented hypersensitivity; severe hepatic dysfunction, children <8 y

Pregnancy

X - Contraindicated; benefit does not outweigh risk

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(last half of pregnancy through 8 y) can cause permanent discoloration of teeth; Fanconilike syndrome may occur with outdated tetracyclines

More on Chronic Fatigue Syndrome

Overview: Chronic Fatigue Syndrome
Differential Diagnoses & Workup: Chronic Fatigue Syndrome
Treatment & Medication: Chronic Fatigue Syndrome
Follow-up: Chronic Fatigue Syndrome
References
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Further Reading

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Keywords

chronic fatigue syndrome, encephalomyalgia, CFS, myalgic encephalomyelitis, fatigue, chronic fatigue, idiopathic fatigue, viral infection, Chlamydia pneumoniae, C pneumoniae, Epstein-Barr virus, EBV infection

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Contributor Information and Disclosures

Author

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.

Medical Editor

Wesley W Emmons, MD, FACP, Assistant Professor, Department of Medicine, Thomas Jefferson University; Consulting Staff, Infectious Diseases Section, Department of Internal Medicine, Christiana Care, Newark, DE
Wesley W Emmons, MD, FACP is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, and International AIDS Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Thomas M Kerkering, MD, Chief of Infectious Diseases, Virginia Tech, Carilion School of Medicine, Roanoke, Virginia
Thomas M Kerkering, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Public Health Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Medical Society of Virginia, and Wilderness Medical Society
Disclosure: Nothing to disclose.

CME Editor

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 Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Association of Professors of Medicine, Association of Program Directors in Internal Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

 
 
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