Trench Fever Medication

Updated: Jan 17, 2020
  • Author: Sarah Perloff, DO, FACP; Chief Editor: John L Brusch, MD, FACP  more...
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Medication Summary

The goal of antibiotic therapy is to eradicate all forms of B quintana infection, minimizing morbidity and mortality.



Class Summary

Antibiotic therapy must be comprehensive and cover all likely pathogens in the context of this clinical setting.

Doxycycline (Vibramycin, Adoxa, Monodox)

Doxycycline is a synthetically derived broad-spectrum antibiotic in the tetracycline class. It is almost completely absorbed, is concentrated in bile, and is excreted in urine and feces as a biologically active metabolite in high concentrations. Doxycycline is bacteriostatic, and its mechanism of action is inhibition of protein synthesis through binding to the 50S subunit of the ribosome. Tetracyclines, as a class, evoke a dramatic response, with rapid disappearance of the associated symptoms and defervescence (usually in 1-2 days).

Ceftriaxone (Rocephin)

Ceftriaxone is a third-generation cephalosporin with broad-spectrum gram-negative activity; it has lower efficacy against gram-positive organisms and higher efficacy against resistant organisms. Ceftriaxone is bactericidal; it arrests bacterial growth by binding to 1 or more of the penicillin-binding proteins.


Gentamicin is an aminoglycoside antibiotic used for coverage of gram-negative bacteria, including Pseudomonas species. It is synergistic with beta-lactamase against enterococci. It interferes with bacterial protein synthesis by binding to 30S and 50S ribosomal subunits.

Dosing regimens for gentamicin are numerous and are adjusted on the basis of creatinine clearance and changes in the volume of distribution, as well as the body space into which the agent must distribute. Doses may be given either intravenously or intramuscularly. Each regimen must be followed by at least a trough level drawn on the third or fourth dose, 30 minutes before dosing; a peak level may be drawn 30 minutes after a 30-minute infusion.

Gentamicin is used in combination with both an agent that covers gram-positive organisms and one that covers anaerobes. It may be considered if penicillins or other less toxic drugs are contraindicated, if there are particular clinical indications for its use, or if a patient has a mixed infection caused by susceptible staphylococci and gram-negative organisms.

Erythromycin (E.E.S., Ery-Tab, Erythrocin)

Erythromycin is a highly bacteriostatic macrolide antibiotic isolated from a Streptomyces strain. Its spectrum is between those of penicillin and tetracyclines. The mechanism of action involves binding to the 50S ribosomal subunit and inhibiting microbial protein synthesis.