Leptospirosis Medication_ Antibiotics, Corticosteroids

10/28/2015 Leptospirosis Medication: Antibiotics, Corticosteroids

http://emedicine.medscape.com/article/220563medication 1/6

Leptospirosis MedicationAuthor: Sandra G Gompf, MD, FACP, FIDSA; Chief Editor: Michael Stuart Bronze, MD more...

Updated: Apr 14, 2015

Medication SummaryTreatment for leptospirosis consists of empiric antibiotic therapy. In general,antibiotic therapy should be effective against leptospirosis and against the otherpathogens considered in the differential diagnoses. If renal failure ensues,corticosteroids may be considered. Additional supportive care may include inotropicagents, diuretics, or ophthalmic drops. Currently, no human vaccine againstleptospirosis is available.

Antibiotics

Class Summary

For severe leptospirosis, intravenous penicillin G has long been considered the drugof choice. Doxycycline is used for the treatment of mild leptospirosis. Ampicillin oramoxicillin are alternatives for the treatment of mild leptospirosis. Erythromycin isthe therapy of choice in pregnant patients who are allergic to penicillin. Thirdgeneration cephalosporins have become widely used for intravenous antibiotictreatment in patients with severe leptospirosis.

View full drug information

Penicillin G aqueous (PfizerpenG)

Intravenous penicillin is firstline antibiotic therapy for severe leptospirosis. Penicillininterferes with synthesis of cell wall mucopeptide during active multiplication,resulting in bactericidal activity against susceptible microorganisms.


Doxycycline (Vibramycin, Doryx, Adoxa)

Doxycycline inhibits protein synthesis, and thus bacterial growth, by binding to 30Sand possibly 50S ribosomal subunits of susceptible bacteria. Excretion ishepatobiliary and renal.


Ampicillin

Ampicillin is a secondline agent or for patients younger than 8 years of age, inwhom doxycycline is contraindicated. This agent interferes with synthesis of cellwallmucopeptides during active multiplication, resulting in bactericidal activity. Excretionis primarily renal, although some ampicillin is metabolized by the liver.


Amoxicillin (Moxatag)

Amoxicillin is a secondline agent or for patients younger than 8 years of age, inwhom doxycycline is contraindicated. This agent interferes with synthesis of cell wallmucopeptides during active multiplication, resulting in bactericidal activity againstsusceptible bacteria.


Erythromycin ethylsuccinate (E.E.S., EryPed, Erythrocin, PCE, EryTab)

Erythromycin inhibits bacterial growth, possibly by blocking dissociation of peptidyltRNA from ribosomes, causing RNAdependent protein synthesis to arrest. Inpregnant patients who are allergic to penicillin, erythromycin is the therapy ofchoice.

Cefotaxime (Claforan)

A thirdgeneration cephalosporin with broad gramnegative spectrum, cefotaximehas lower efficacy against grampositive organisms and higher efficacy againstresistant organisms. This agent arrests bacterial cell wall synthesis by binding toone or more of the penicillinbinding proteins, which in turn inhibits bacterial growth.


Ceftriaxone (Rocephin)

Ceftriaxone is a thirdgeneration cephalosporin with broadspectrum, gramnegativeactivity. It has lower efficacy against grampositive organisms and higher efficacyagainst resistant organisms.

Ceftriaxone exerts its bactericidal effect by interfering with the synthesis ofpeptidoglycan, a major structural component of bacterial cell walls. Bacteria

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eventually lyse owing to the ongoing activity of cell wall autolytic enzymes while cellwall assembly is arrested.

Ceftriaxone is highly stable in presence of betalactamases, both penicillinase andcephalosporinase, produced by gramnegative and grampositive bacteria.Approximately 3367% of the dose is excreted unchanged in urine; the remainder issecreted in bile and ultimately in feces as microbiologically inactive compounds.

This agent reversibly binds to human plasma proteins. Binding has been reported todecrease with increasing plasma concentrations of the drug, from 95% bound atplasma concentrations < 25 mcg/mL to 85% bound at 300 mcg/mL.

Corticosteroids

Class Summary

In patients with leptospirosis, corticosteroids are indicated to improve renal failureoutcome.


Methylprednisolone (AMethapred, Medrol, DepoMedrol, SoluMedrol)

Methylprednisolone decreases inflammation by suppressing the migration ofpolymorphonuclear leukocytes and reversing increased capillary permeability. Highdose pulsed methylprednisolone (30 mg/kg/d, not to exceed 1500 mg) has beenused successfully to treat patients with leptospiral renal failure without dialysis.

Contributor Information and DisclosuresAuthorSandra G Gompf, MD, FACP, FIDSA Associate Professor of Infectious Diseases and International Medicine,University of South Florida College of Medicine; Chief, Infectious Diseases Section, Director, OccupationalHealth and Infection Control Programs, James A Haley Veterans Hospital

Sandra G Gompf, MD, FACP, FIDSA is a member of the following medical societies: American College ofPhysicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Coauthor(s)Judith GreenMcKenzie, MD, MPH, FACP, FACOEM Associate Professor, Director of Clinical Practice,Occupational Medicine Residency Director, University of Pennsylvania School of Medicine

Judith GreenMcKenzie, MD, MPH, FACP, FACOEM is a member of the following medical societies: AmericanCollege of Physicians, American College of Preventive Medicine, National Medical Association, AmericanCollege of Occupational and Environmental Medicine


Ana Paula Velez, MD Assistant Professor of Medicine, Division of Infectious Disease and InternationalMedicine, University of South Florida College of Medicine and James A Haley Veterans Affairs Medical Center;Attending Physician, Moffitt Cancer Center

Ana Paula Velez, MD is a member of the following medical societies: American College of PhysiciansAmericanSociety of Internal Medicine, American Medical Association, Infectious Diseases Society of America


Chief EditorMichael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart GWolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health ScienceCenter; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, AmericanMedical Association, Oklahoma State Medical Association, Southern Society for Clinical Investigation,Association of Professors of Medicine, American College of Physicians, Infectious Diseases Society of America


AcknowledgementsDenise Demers, MD, FAAP Assistant Professor of Pediatrics, Uniformed Services University of the HealthSciences; Attending Physician, Division of Pediatric Infectious Diseases, Department of Pediatrics, Tripler ArmyMedical Center


Juan D Diaz, DO Fellow in Infectious Diseases, University of South Florida College of Medicine, Tampa GeneralHospital, and James A Haley Veterans Hospital


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, AmericanAcademy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, PediatricInfectious Diseases Society, and Phi Beta Kappa


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

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


Edmond A Hooker II, MD, DrPH, FAAEM Assistant Professor, Department of Emergency Medicine, Universityof Cincinnati College of Medicine; Associate Professor, Department of Health Services Administration, XavierUniversity

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Matthew R Jezior, MD Fellow, Department of Cardiology, Walter Reed Medical Center


Maria D Mileno, MD Associate Professor of Medicine, Division of Infectious Diseases, The Warren AlpertMedical School of Brown University

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Joseph T Morris, MD Chief of Infectious Disease Service, Madigan Army Medical Center; Assistant Professor,Department of Internal Medicine, Uniformed Services University of the Health Sciences


Gary J Noel, MD Professor, Department of Pediatrics, Weill Cornell Medical College; Attending Pediatrician,New YorkPresbyterian Hospital

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


Cecily K Peterson, MD Program Director, Clinical Faculty, Department of Medicine, Madigan Army MedicalCenter


Charles V Sanders, MD Edgar Hull Professor and Chairman, Department of Internal Medicine, Professor ofMicrobiology, Immunology and Parasitology, Louisiana State University School of Medicine at New Orleans;Medical Director, Medicine Hospital Center, Charity Hospital and Medical Center of Louisiana at New Orleans;Consulting Staff, Ochsner Medical Center

Charles V Sanders, MD is a member of the following medical societies: Alliance for the Prudent Use ofAntibiotics, Alpha Omega Alpha, American Association for the Advancement of Science, American Associationof University Professors, American Clinical and Climatological Association, American College of PhysicianExecutives, American College of Physicians, American Federation for Medical Research, American Foundationfor AIDS Research, AmericanGeriatricsSociety, American Lung Association, American Medical Association,American Society for Microbiology, American Thoracic Society, American Venereal Disease Association,Association for Professionals in Infection Control and Epidemiology, Association of American Medical Colleges,Association of American Physicians, Association of Professors of Medicine, Infectious Disease Society forObstetrics and Gynecology, InfectiousDiseases Societyof America, Louisiana State Medical Society, OrleansParish Medical Society, Royal Society of Medicine, Sigma Xi, Society of General Internal Medicine,Southeastern Clinical Club, Southern Medical Association, Southern Society for Clinical Investigation, andSouthwestern Association of Clinical Microbiology


William H Shoff, MD, DTM&H Director, PENN Travel Medicine; Associate Professor, Department of EmergencyMedicine, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine

William H Shoff, MD, DTM&H is a member of the following medical societies: American College of Physicians,American Society of Tropical Medicine and Hygiene, International Society of Travel Medicine, Society forAcademic Emergency Medicine, and Wilderness Medical Society


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


Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center Collegeof Pharmacy; EditorinChief, Medscape Drug Reference

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Jeter (Jay) Pritchard Taylor III, MD Compliance Officer, Attending Physician, Emergency Medicine Residency,Department of Emergency Medicine, Palmetto Health Richland, University of South Carolina School of Medicine;Medical Director, Department of Emergency Medicine, Palmetto Health Baptist

Jeter (Jay) Pritchard Taylor III, MD is a member of the following medical societies: American Academy ofEmergency Medicine, American College of Emergency Physicians, American Medical Association, and Societyfor Academic Emergency Medicine


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Leptospirosis Medication_ Antibiotics, Corticosteroids