Pediatric Leptospirosis Medication

  • Author: Patrick W Hickey, MD, FAAP; Chief Editor: Russell W Steele, MD   more...
 
Updated: Jul 27, 2010
 

Medication Summary

Treatment for leptospirosis consists of empiric antibiotic therapy. If renal failure ensues, corticosteroids may be considered. Additional supportive care may include inotropic agents, diuretics, or ophthalmic drops.

Next

Antibiotics

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

View full drug information

Penicillin G (Pfizerpen)

 

DOC in adults with moderate to severe disease; interferes with synthesis of cell wall mucopeptide during active multiplication, resulting in bactericidal activity against susceptible microorganisms.

View full drug information

Doxycycline (Doxy, Vibramycin, Vibra-Tabs)

 

Used for only mild disease; inhibits protein synthesis and thus bacterial growth by binding to 30S and, possibly, 50S ribosomal subunits.

View full drug information

Ampicillin (Marcillin, Omnipen, Polycillin, Principen, Totacillin)

 

Second-line agent or for patients < 8 y in whom doxycycline contraindicated; interferes with synthesis of cell-wall mucopeptides during active multiplication, resulting in bactericidal activity.

View full drug information

Amoxicillin (Amoxil, Biomox, Trimox)

 

Second-line agent or for patients < 8 y in whom doxycycline contraindicated; interferes with synthesis of cell-wall mucopeptides during active multiplication, resulting in bactericidal activity.

Previous
Proceed to Follow-up
 
 
Contributor Information and Disclosures
Author

Patrick W Hickey, MD, FAAP  Assistant Professor of Pediatrics and Preventive Medicine, Uniformed Services University of the Health Sciences; Consulting Staff, Department of Pediatrics, Division of Pediatric Infectious Disease, Walter Reed Army Medical Center

Patrick W Hickey, MD, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society of Tropical Medicine and Hygiene, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Gary J Noel, MD  Department of Pediatrics, Clinical Associate Professor, Weill Medical College of Cornell University

Gary J Noel, MD is a member of the following medical societies: Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Joseph Domachowske, MD  Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University

Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Sanofi Pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

References

  1. Inada R, Ido Y, Hoki R. The etiology, mode of infection, and specific therapy of Weil's disease (spirochaetosis icterohaemorrhagica). J Exper Med. 1916;23:377-402.

  2. World Health Organization. Human leptospirosis: guidance for diagnosis, surveillance and control. Available at http://whqlibdoc.who.int/hq/2003/WHO_CDS_CSR_EPH_2002.23.pdf. Accessed September 17, 2008.

  3. Gillespie RW, Ryno J. Epidemiology of leptospirosis. Am J Public Health. Jun 1963;53:950-5. [Medline].

  4. Heisey GB, Nimmanitya S, Karnchanachetanee C, et al. Epidemiology and characterization of leptospirosis at an urban and provincial site in Thailand. Southeast Asian J Trop Med Public Health. Jun 1988;19(2):317-22. [Medline].

  5. Barkin RM, Guckian JC, Glosser JW. Infection by leptospira ballum: a laboratory-associated case. South Med J. Feb 1974;67(2):155 passim. [Medline].

  6. Shaked Y, Shpilberg O, Samra D, Samra Y. Leptospirosis in pregnancy and its effect on the fetus: case report and review. Clin Infect Dis. Aug 1993;17(2):241-3. [Medline].

  7. Smith DJ, Self HR. Observations on the survival of Leptospira australis A in soil and water. J Hyg (Lond). Dec 1955;53(4):436-44. [Medline].

  8. Trevejo RT, Rigau-Perez JG, Ashford DA, et al. Epidemic leptospirosis associated with pulmonary hemorrhage-Nicaragua, 1995. J Infect Dis. Nov 1998;178(5):1457-63. [Medline].

  9. Jackson LA, Kaufmann AF, Adams WG, et al. Outbreak of leptospirosis associated with swimming. Pediatr Infect Dis J. Jan 1993;12(1):48-54. [Medline].

  10. Everard CO, Bennett S, Edwards CN, et al. An investigation of some risk factors for severe leptospirosis on Barbados. - Carrington DG. Feb 1992;95(1):13-22. [Medline].

  11. Katz AR, Manea SJ, Sasaki DM. Leptospirosis on Kauai: investigation of a common source waterborne outbreak. Am J Public Health. Oct 1991;81(10):1310-2. [Medline].

  12. US Department of Health and Human Services. Summary of notifiable diseases, United States 1995. MMWR Morb Mortal Wkly Rep. Oct 25 1996;44(53):1-87. [Medline].

  13. Malani J, Pryor J, Lusangulira K. Leptospirosis in Pohnpei (1986-1995): a case series on the use of dopamine/steroid for Weil's syndrome. Pacific Health Dialog. 1996;3:153-61.

  14. Lettieri C, Moon J, Hickey P, et al. Prevalence of leptospira antibodies in U.S. Army blood bank donors in Hawaii. Mil Med. Sep 2004;169(9):687-90. [Medline].

  15. Sasaki DM, Pang L, Minette HP, et al. Active surveillance and risk factors for leptospirosis in Hawaii. Am J Trop Med Hyg. Jan 1993;48(1):35-43. [Medline].

  16. Demers RY, Thiermann A, Demers P, Frank R. Exposure to Leptospira icterohaemorrhagiae in inner-city and suburban children: a serologic comparison. J Fam Pract. Dec 1983;17(6):1007-11. [Medline].

  17. Childs JE, Schwartz BS, Ksiazek TG, Graham RR, LeDuc JW, Glass GE. Risk factors associated with antibodies to leptospires in inner-city residents of Baltimore: a protective role for cats. Am J Public Health. Apr 1992;82(4):597-9. [Medline].

  18. Hawaii Dept of Health. Communicable Disease Surveillance. Hawaii: Communicable Disease Report; Nov/Dec 1999. 15.

  19. Person DA, Burnett MW. Leptospirosis- Tripler Army Medical Center. Medical Surveillance Monthly Report. 1996;2:7-8. [Full Text].

  20. Person DA. Leptospirosis in the Pacific: Tripler Army Medical Center. Medical Surveillance Monthly Report. 1998;4:12-14. [Full Text].

  21. Musgrave JE, Person DA. Acute renal failure in children due to leptospirosis. Pac Health Dialog. 1996;3:200-1.

  22. Watt G, Padre LP, Tuazon M, Calubaquib C. Skeletal and cardiac muscle involvement in severe, late leptospirosis. J Infect Dis. Jul 1990;162(1):266-9. [Medline].

  23. Arean VM. The pathologic anatomy and pathogenesis of fatal human leptospirosis (Weil's disease). Am J Pathol. Apr 1962;40:393-423. [Medline].

  24. Phimda K, Hoontrakul S, Suttinont C, et al. Doxycycline versus azithromycin for treatment of leptospirosis and scrub typhus. Antimicrob Agents Chemother. Sep 2007;51(9):3259-63. [Medline].

  25. Murray CK, Hospenthal DR. Determination of susceptibilities of 26 Leptospira sp. serovars to 24 antimicrobial agents by a broth microdilution technique. Antimicrob Agents Chemother. Oct 2004;48(10):4002-5. [Medline].

  26. Watt G, Padre LP, Tuazon ML, et al. Placebo-controlled trial of intravenous penicillin for severe and late leptospirosis. Lancet. Feb 27 1988;1(8583):433-5. [Medline].

  27. Costa E, Lopes AA, Sacramento E, et al. Penicillin at the late stage of leptospirosis: a randomized controlled trial. Rev Inst Med Trop Sao Paulo. May-Jun 2003;45(3):141-5. [Medline].

  28. Trivedi SV, Chavda RK, Wadia PZ, et al. The role of glucocorticoid pulse therapy in pulmonary involvement in leptospirosis. J Assoc Physicians India. Sep 2001;49:901-3. [Medline].

  29. Shenoy VV, Nagar VS, Chowdhury AA, et al. Pulmonary leptospirosis: an excellent response to bolus methylprednisolone. Postgrad Med J. Sep/2006;82:601-6. [Medline].

  30. Martins MG, Matos KT, da Silva MV, de Abreu MT. Ocular manifestations in the acute phase of leptospirosis. Ocul Immunol Inflamm. Jun 1998;6(2):75-9. [Medline].

  31. Takafuji ET, Kirkpatrick JW, Miller RN, et al. An efficacy trial of doxycycline chemoprophylaxis against leptospirosis. N Engl J Med. Feb 23 1984;310(8):497-500. [Medline].

  32. Abdulkader RC, Seguro AC, Malheiro PS, et al. Peculiar electrolytic and hormonal abnormalities in acute renal failure due to leptospirosis. Am J Trop Med Hyg. Jan 1996;54(1):1-6. [Medline].

  33. Arean VM. Studies on the pathogenesis of leptospirosis. II. A clinicopathologic evaluation of hepatic and renal function in experimental leptospiral infections. Lab Invest. Apr 1962;11:273-88. [Medline].

  34. Arean VM, Sarasin G, Green JH. The pathogenesis of leptospirosis: toxin production by leptospira icterohaemorrhagiae. Am J Vet Res. May 1964;25:836-43. [Medline].

  35. Barkay S, Garzozi H. Leptospirosis and uveitis. Ann Ophthalmol. Feb 1984;16(2):164-8. [Medline].

  36. Bauer DC, Eames LN, Sleight SD, Ferguson LC. The significance of leptospiral hemolysin in the pathogenesis of Leptospira pomona infections. J Infect Dis. Mar-Apr 1961;108:229-36. [Medline].

  37. Bowsher B, Callahan CW, Person DA, Ruess L. Unilateral leptospiral pneumonia and cold agglutinin disease. Chest. Sep 1999;116(3):830-2. [Medline].

  38. Cargill WH, Beeson PB. The value of spinal fluid examination as a diagnostic procedure in Weil's disease. Ann Intern Med. 1947;27:396-400.

  39. De Brito T, Bohm GM, Yasuda PH. Vascular damage in acute experimental leptospirosis of the guinea-pig. J Pathol. Aug 1979;128(4):177-82. [Medline].

  40. De Brito T, Morais CF, Yasuda PH, et al. Cardiovascular involvement in human and experimental leptospirosis: pathologic findings and immunohistochemical detection of leptospiral antigen. Ann Trop Med Parasitol. Jun 1987;81(3):207-14. [Medline].

  41. Effler PV, Bogard AK, Domen HY, Katz AR, Higa HY, Sasaki DM. Evaluation of eight rapid screening tests for acute leptospirosis in Hawaii. J Clin Microbiol. Apr 2002;40(4):1464-9. [Medline].

  42. Effler PV, Domen HY, Bragg SL, Aye T, Sasaki DM. Evaluation of the indirect hemagglutination assay for diagnosis of acute leptospirosis in Hawaii. J Clin Microbiol. Mar 2000;38(3):1081-4. [Medline].

  43. Emmanouilides CE, Kohn OF, Garibaldi R. Leptospirosis complicated by a Jarisch-Herxheimer reaction and adult respiratory distress syndrome: case report. Clin Infect Dis. Jun 1994;18(6):1004-6. [Medline].

  44. Finco DR, Low DG. Endotoxin properties of Leptospira canicola. Am J Vet Res. Nov 1967;28(127):1863-72. [Medline].

  45. Kasarov LB, Addamiano L. Metabolism of the lipoproteins of serum by leptospires: degradation of the triglycerides. J Med Microbiol. May 1969;2(2):165-8. [Medline].

  46. Levett PN, Branch SL, Whittington CU, et al. Two methods for rapid serological diagnosis of acute leptospirosis. Clin Diagn Lab Immunol. Mar 2001;8(2):349-51. [Medline].

  47. Levett PN, Whittington CU. Evaluation of the indirect hemagglutination assay for diagnosis of acute leptospirosis. J Clin Microbiol. Jan 1998;36(1):11-4. [Medline].

  48. Marotto PC, Marotto MS, Santos DL, et al. Outcome of leptospirosis in children. Am J Trop Med Hyg. Mar 1997;56(3):307-10. [Medline].

  49. McClain JB, Ballou WR, Harrison SM, Steinweg DL. Doxycycline therapy for leptospirosis. Ann Intern Med. May 1984;100(5):696-8. [Medline].

  50. McCulloch WF, Braun JL, Robinson RG. Leptospiral Meningitis: report of a case and epidemiologic follow up. J Iowa Med Soc. 1962;52:728-31.

  51. Molner JG, Meyer KF, Raskin HA. Leptospiral infections. JAMA. 1948;136:814-19.

  52. Monno S, Mizushima Y. Leptospirosis with acute acalculous cholecystitis and pancreatitis. J Clin Gastroenterol. Jan 1993;16(1):52-4. [Medline].

  53. Munnich D, Lakatos M. Treatment of human leptospira infections with semicillin (ampicillin) or with amoxil (amoxycillin). Chemotherapy. 1976;22(6):372-80. [Medline].

  54. Nicodemo AC, Duarte MI, Alves VA, et al. Lung lesions in human leptospirosis: microscopic, immunohistochemical, and ultrastructural features related to thrombocytopenia. Am J Trop Med Hyg. Feb 1997;56(2):181-7. [Medline].

  55. O'Brien MM, Vincent JM, Person DA, Cook BA. Leptospirosis and pancreatitis: a report of ten cases. Pediatr Infect Dis J. May 1998;17(5):436-8. [Medline].

  56. Ramos-Morales F, Diaz-Rivera RS, Cintron-Rivera AA, et al. The pathogenesis of leptospiral jaundice. Ann Intern Med. Nov 1959;51:861-78. [Medline].

  57. Ruof HR, Rudin C, Heininger U. Influenza-like symptoms and thrombocytopenia in a teenager. Pediatr Infect Dis J. Jan 2003;22(1):89, 101-2. [Medline].

  58. Shenberg E, Gerichter CB, Lindenbaum I. Leptospirosis in man, Israel, 1970-1979. Am J Epidemiol. Mar 1982;115(3):352-8. [Medline].

  59. Shpilberg O, Shaked Y, Maier MK, et al. Long-term follow-up after leptospirosis. South Med J. Apr 1990;83(4):405-7. [Medline].

  60. Sitprija V. Renal involvement in human leptospirosis. Br Med J. Jun 15 1968;2(606):656-8. [Medline].

  61. Sitprija V, Evans H. The kidney in human leptospirosis. Am J Med. Dec 1970;49(6):780-8. [Medline].

  62. Stavitsky AB. Studies on the pathogenesis of leptospirosis. J Infect Dis. 1945;76:179-192.

  63. Wong ML, Kaplan S, Dunkle LM, et al. Leptospirosis: a childhood disease. J Pediatr. Apr 1977;90(4):532-7. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.