eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Rocky Mountain Spotted Fever: Treatment & Medication

Author: Nicholas John Bennett, MB, BCh, PhD, Fellow in Pediatric Infectious Disease, Department of Pediatrics, State University of New York Upstate Medical University
Coauthor(s): Joseph Domachowske, MD, Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York-Upstate Medical University; Walid Abuhammour, MD, FAAP, Associate Professor of Pediatrics, Michigan State University; Director of Pediatric Infectious Disease, Department of Pediatrics, Hurley Medical Center
Contributor Information and Disclosures

Updated: Sep 10, 2009

Treatment

Medical Care

  • Early treatment is critical to the outcome in Rocky Mountain spotted fever (RMSF) and must be started on the basis of clinical diagnosis.4 Consider Rocky Mountain spotted fever (RMSF) and promptly begin medical treatment in any person with a potential exposure to the pathogen who develops fever, myalgia, or headache, even if they do not have of a rash. The best outcomes are achieved when treatment is started within 4 days of symptom onset.
  • Provide supportive care. Doxycycline is the antibiotic of choice.5 Chloramphenicol was previously recommended for the treatment of children younger than 9 years. However, in national surveillance data, patients treated with chloramphenicol were more likely to die than those treated with tetracycline. Staining of teeth caused by one or more courses of tetracyclines (particularly doxycycline) is negligible.
  • For children who weigh less than 45 kg, the dose is 2 mg/kg given orally or intravenously twice daily on the first day of treatment and once or twice daily thereafter. Older children and adults should receive 100 mg twice daily on the first day and once or twice daily thereafter.
  • Antibiotics should be continued for a minimum of 5-7 days and until the patient has been afebrile for at least 1 day.
  • Some have advocated the use of corticosteroids, but the specific therapeutic benefits of these drugs are not known. Physicians should be aware that sulfonamide treatment given empirically in a febrile child can worsen Rocky Mountain spotted fever.

Consultations

  • Patients with Rocky Mountain spotted fever should be treated in consultation with an infectious disease specialist.

Medication

Antibiotic agents

Tetracyclines are the drug of choice. Although tetracyclines should not be routinely prescribed to children younger than 8 years, the benefits far exceed the risks in treating Rocky Mountain spotted fever (RMSF). Doxycycline is the agent of choice because the risk of dental staining is less than that of other tetracyclines. Chloramphenicol was previously recommended for use in children younger than 8 years (to avoid teeth staining), but it poses a risk of permanent aplastic anemia and should be avoided if at all possible


Doxycycline (Bio-Tab, Doxy, Vibramycin)

Broad-spectrum, synthetically derived bacteriostatic antibiotic in tetracycline class. Almost completely absorbed, concentrates in bile, and excreted in urine and feces as biologically active metabolite in high concentrations.
Inhibits protein synthesis and, therefore, bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria. May block dissociation of peptidyl transfer RNA (tRNA) from ribosomes, arresting RNA-dependent protein synthesis. Drug of choice for RMSF. Only tetracycline that does not need dosing adjustment in renal failure.

Adult

Days 1-3: 200 mg PO/IV q12h
Days 4-7: 100 mg PO/IV q12h for 7 d or through third day of defervescence

Pediatric

<45 kg:
Day 1: 2 mg/kg PO/IV bid
Days 2-7: 2 mg/kg PO/IV qd/bid
Administer for at least 7 d and for at least 3 d after defervescence
>45 kg: Administer as in adults

Bioavailability decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; tetracyclines can increase hypoprothrombinemic effects of anticoagulants; tetracyclines can decrease effects of PO contraceptives, causing breakthrough bleeding and increasing risk of pregnancy

Documented hypersensitivity; severe hepatic dysfunction

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Avoid if possible in breastfeeding women; tooth discoloration depends on number of courses of therapy and specific tetracyclines used; oxytetracyclines produce least tooth staining; tetracyclines associated with rare cases of liver injury (dose related; risk increases with pregnancy, malnutrition, and use of other hepatotoxic agents); photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; consider drug serum level determinations in prolonged therapy; Fanconilike syndrome may occur with outdated tetracyclines

More on Rocky Mountain Spotted Fever

Overview: Rocky Mountain Spotted Fever
Differential Diagnoses & Workup: Rocky Mountain Spotted Fever
Treatment & Medication: Rocky Mountain Spotted Fever
Follow-up: Rocky Mountain Spotted Fever
Multimedia: Rocky Mountain Spotted Fever
References
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References

  1. Chapman AS, Bakken JS, Folk SM, et al. Diagnosis and management of tickborne rickettsial diseases: Rocky Mountain spotted fever, ehrlichioses, and anaplasmosis--United States: a practical guide for physicians and other health-care and public health professionals. MMWR Recomm Rep. Mar 31 2006;55(RR-4):1-27. [Medline]. [Full Text].

  2. Holman RC, McQuiston JH, Haberling DL, Cheek JE. Increasing incidence of Rocky Mountain spotted fever among the American Indian population in the United States. Am J Trop Med Hyg. Apr 2009;80(4):601-5. [Medline].

  3. Adjemian JZ, Krebs J, Mandel E, McQuiston J. Spatial clustering by disease severity among reported Rocky Mountain spotted fever cases in the United States, 2001-2005. Am J Trop Med Hyg. Jan 2009;80(1):72-7. [Medline].

  4. [Guideline] Chapman AS, Bakken JS, Folk SM, et al. Diagnosis and management of tickborne rickettsial diseases: Rocky Mountain spotted fever, ehrlichioses, and anaplasmosis--United States: a practical guide for physicians and other health-care and public health professionals. MMWR Recomm Rep. Mar 31 2006;55:1-27. [Medline]. [Full Text].

  5. Cale DF, McCarthy MW. Treatment of Rocky Mountain spotted fever in children. Ann Pharmacother. Apr 1997;31(4):492-4. [Medline].

  6. Abramson JS, Givner LB. Rocky Mountain spotted fever. Pediatr Infect Dis J. Jun 1999;18(6):539-40. [Medline].

  7. American Academy of Pediatrics Committee on Infectious Diseases. Rocky Mountain spotted fever. In: Red Book. 27th Ed. Elk Grove Village, IL: AAP; 2006:570-2.

  8. Azad AF, Beard CB. Rickettsial pathogens and their arthropod vectors. Emerg Infect Dis. Apr-Jun 1998;4(2):179-86. [Medline].

  9. Kostman JR. Laboratory diagnosis of rickettsial diseases. Clin Dermatol. May-Jun 1996;14(3):301-6. [Medline].

  10. Thorner AR, Walker DH, Petri WA. Rocky mountain spotted fever. Clin Infect Dis. Dec 1998;27(6):1353-9; quiz 1360. [Medline].

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Further Reading

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Keywords

Rocky Mountain spotted fever, RMSF, tick-borne disease, Rickettsia rickettsii, R rickettsii, black measles, Lyme disease, vasculitis, edema of the medulla oblongata, rickettsial disease, glucose-6-phosphate dehydrogenase, G-6-PD deficiency, conjunctival hyperemia, photophobia, hepatomegaly, splenomegaly, meningoencephalitis, meningismus

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Contributor Information and Disclosures

Author

Nicholas John Bennett, MB, BCh, PhD, Fellow in Pediatric Infectious Disease, Department of Pediatrics, State University of New York Upstate Medical University
Nicholas John Bennett, MB, BCh, PhD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Pediatrics
Disclosure: Nothing to disclose.

Coauthor(s)

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.

Walid Abuhammour, MD, FAAP, Associate Professor of Pediatrics, Michigan State University; Director of Pediatric Infectious Disease, Department of Pediatrics, Hurley Medical Center
Walid Abuhammour, MD, FAAP is a member of the following medical societies: American Medical Association and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Medical Editor

José Rafael Romero, MD, Director of Pediatric Infectious Diseases Fellowship Program, Associate Professor, Department of Pediatrics, Combined Division of Pediatric Infectious Diseases, Creighton University/University of Nebraska Medical Center
José Rafael Romero, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, New York Academy of Sciences, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Larry I Lutwick, MD, Professor of Medicine, State University of New York, Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus
Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

CME Editor

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

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: None None None

 
 
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