Pediatric Rocky Mountain Spotted Fever Medication

Updated: Aug 14, 2018
  • Author: Nicholas John Bennett, MBBCh, PhD, MA(Cantab), FAAP; Chief Editor: Russell W Steele, MD  more...
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Medication

Medication Summary

The best outcomes in Rocky Mountain spotted fever (RMSF) are achieved when treatment is started within 4 days of symptom onset. Doxycycline is the antibiotic of choice.

Chloramphenicol was previously recommended for the treatment of children younger than 9 years. In national surveillance data, however, patients treated with chloramphenicol were more likely to die than those treated with a tetracycline. Chloramphenicol poses a risk of permanent aplastic anemia and should be avoided if at all possible.

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Antibiotic Agents

Class Summary

Tetracyclines are the drugs of choice. Although tetracyclines should not be routinely prescribed to children younger than 8 years, the benefits far exceed the risks in RMSF. Doxycycline is the agent of choice because the risk of dental staining is less with this agent than with other tetracyclines.

Doxycycline (Adoxa, Doxy 100, Vibramycin, Monodox)

Doxycycline is the drug of choice for RMSF. It is a broad-spectrum, synthetically derived bacteriostatic antibiotic in the tetracycline class. When given orally, it is almost completely absorbed.

It concentrates in bile and is excreted in urine and feces as a biologically active metabolite in high concentrations. This agent is the only tetracycline that does not need dosing adjustment in renal failure.

Doxycycline inhibits protein synthesis and, therefore, bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria. It may block dissociation of peptidyl transfer RNA (tRNA) from ribosomes, arresting RNA-dependent protein synthesis.

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