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10/28/2015

LeptospirosisMedication:Antibiotics,Corticosteroids

LeptospirosisMedication
Author:SandraGGompf,MD,FACP,FIDSAChiefEditor:MichaelStuartBronze,MDmore...
Updated:Apr14,2015

MedicationSummary
Treatmentforleptospirosisconsistsofempiricantibiotictherapy.Ingeneral,
antibiotictherapyshouldbeeffectiveagainstleptospirosisandagainsttheother
pathogensconsideredinthedifferentialdiagnoses.Ifrenalfailureensues,
corticosteroidsmaybeconsidered.Additionalsupportivecaremayincludeinotropic
agents,diuretics,orophthalmicdrops.Currently,nohumanvaccineagainst
leptospirosisisavailable.

Antibiotics
ClassSummary
Forsevereleptospirosis,intravenouspenicillinGhaslongbeenconsideredthedrug
ofchoice.Doxycyclineisusedforthetreatmentofmildleptospirosis.Ampicillinor
amoxicillinarealternativesforthetreatmentofmildleptospirosis.Erythromycinis
thetherapyofchoiceinpregnantpatientswhoareallergictopenicillin.Third
generationcephalosporinshavebecomewidelyusedforintravenousantibiotic
treatmentinpatientswithsevereleptospirosis.
Viewfulldruginformation

PenicillinGaqueous(PfizerpenG)
Intravenouspenicillinisfirstlineantibiotictherapyforsevereleptospirosis.Penicillin
interfereswithsynthesisofcellwallmucopeptideduringactivemultiplication,
resultinginbactericidalactivityagainstsusceptiblemicroorganisms.
Viewfulldruginformation

Doxycycline(Vibramycin,Doryx,Adoxa)
Doxycyclineinhibitsproteinsynthesis,andthusbacterialgrowth,bybindingto30S
andpossibly50Sribosomalsubunitsofsusceptiblebacteria.Excretionis
hepatobiliaryandrenal.
Viewfulldruginformation

Ampicillin
Ampicillinisasecondlineagentorforpatientsyoungerthan8yearsofage,in
whomdoxycyclineiscontraindicated.Thisagentinterfereswithsynthesisofcellwall
mucopeptidesduringactivemultiplication,resultinginbactericidalactivity.Excretion
isprimarilyrenal,althoughsomeampicillinismetabolizedbytheliver.
Viewfulldruginformation

Amoxicillin(Moxatag)
Amoxicillinisasecondlineagentorforpatientsyoungerthan8yearsofage,in
whomdoxycyclineiscontraindicated.Thisagentinterfereswithsynthesisofcellwall
mucopeptidesduringactivemultiplication,resultinginbactericidalactivityagainst
susceptiblebacteria.
Viewfulldruginformation

Erythromycinethylsuccinate(E.E.S.,EryPed,Erythrocin,PCE,Ery
Tab)
Erythromycininhibitsbacterialgrowth,possiblybyblockingdissociationofpeptidyl
tRNAfromribosomes,causingRNAdependentproteinsynthesistoarrest.In
pregnantpatientswhoareallergictopenicillin,erythromycinisthetherapyof
choice.

Cefotaxime(Claforan)
Athirdgenerationcephalosporinwithbroadgramnegativespectrum,cefotaxime
haslowerefficacyagainstgrampositiveorganismsandhigherefficacyagainst
resistantorganisms.Thisagentarrestsbacterialcellwallsynthesisbybindingto
oneormoreofthepenicillinbindingproteins,whichinturninhibitsbacterialgrowth.
Viewfulldruginformation

Ceftriaxone(Rocephin)
Ceftriaxoneisathirdgenerationcephalosporinwithbroadspectrum,gramnegative
activity.Ithaslowerefficacyagainstgrampositiveorganismsandhigherefficacy
againstresistantorganisms.
Ceftriaxoneexertsitsbactericidaleffectbyinterferingwiththesynthesisof
peptidoglycan,amajorstructuralcomponentofbacterialcellwalls.Bacteria

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LeptospirosisMedication:Antibiotics,Corticosteroids

eventuallylyseowingtotheongoingactivityofcellwallautolyticenzymeswhilecell
wallassemblyisarrested.
Ceftriaxoneishighlystableinpresenceofbetalactamases,bothpenicillinaseand
cephalosporinase,producedbygramnegativeandgrampositivebacteria.
Approximately3367%ofthedoseisexcretedunchangedinurinetheremainderis
secretedinbileandultimatelyinfecesasmicrobiologicallyinactivecompounds.
Thisagentreversiblybindstohumanplasmaproteins.Bindinghasbeenreportedto
decreasewithincreasingplasmaconcentrationsofthedrug,from95%boundat
plasmaconcentrations<25mcg/mLto85%boundat300mcg/mL.

Corticosteroids
ClassSummary
Inpatientswithleptospirosis,corticosteroidsareindicatedtoimproverenalfailure
outcome.
Viewfulldruginformation

Methylprednisolone(AMethapred,Medrol,DepoMedrol,Solu
Medrol)
Methylprednisolonedecreasesinflammationbysuppressingthemigrationof
polymorphonuclearleukocytesandreversingincreasedcapillarypermeability.High
dosepulsedmethylprednisolone(30mg/kg/d,nottoexceed1500mg)hasbeen
usedsuccessfullytotreatpatientswithleptospiralrenalfailurewithoutdialysis.

ContributorInformationandDisclosures
Author
SandraGGompf,MD,FACP,FIDSAAssociateProfessorofInfectiousDiseasesandInternationalMedicine,
UniversityofSouthFloridaCollegeofMedicineChief,InfectiousDiseasesSection,Director,Occupational
HealthandInfectionControlPrograms,JamesAHaleyVeteransHospital
SandraGGompf,MD,FACP,FIDSAisamemberofthefollowingmedicalsocieties:AmericanCollegeof
Physicians,InfectiousDiseasesSocietyofAmerica
Disclosure:Nothingtodisclose.
Coauthor(s)
JudithGreenMcKenzie,MD,MPH,FACP,FACOEMAssociateProfessor,DirectorofClinicalPractice,
OccupationalMedicineResidencyDirector,UniversityofPennsylvaniaSchoolofMedicine
JudithGreenMcKenzie,MD,MPH,FACP,FACOEMisamemberofthefollowingmedicalsocieties:American
CollegeofPhysicians,AmericanCollegeofPreventiveMedicine,NationalMedicalAssociation,American
CollegeofOccupationalandEnvironmentalMedicine
Disclosure:Nothingtodisclose.
AnaPaulaVelez,MDAssistantProfessorofMedicine,DivisionofInfectiousDiseaseandInternational
Medicine,UniversityofSouthFloridaCollegeofMedicineandJamesAHaleyVeteransAffairsMedicalCenter
AttendingPhysician,MoffittCancerCenter
AnaPaulaVelez,MDisamemberofthefollowingmedicalsocieties:AmericanCollegeofPhysiciansAmerican
SocietyofInternalMedicine,AmericanMedicalAssociation,InfectiousDiseasesSocietyofAmerica
Disclosure:Nothingtodisclose.
ChiefEditor
MichaelStuartBronze,MDDavidRossBoydProfessorandChairman,DepartmentofMedicine,StewartG
WolfEndowedChairinInternalMedicine,DepartmentofMedicine,UniversityofOklahomaHealthScience
CenterMasteroftheAmericanCollegeofPhysiciansFellow,InfectiousDiseasesSocietyofAmerica
MichaelStuartBronze,MDisamemberofthefollowingmedicalsocieties:AlphaOmegaAlpha,American
MedicalAssociation,OklahomaStateMedicalAssociation,SouthernSocietyforClinicalInvestigation,
AssociationofProfessorsofMedicine,AmericanCollegeofPhysicians,InfectiousDiseasesSocietyofAmerica
Disclosure:Nothingtodisclose.
Acknowledgements
DeniseDemers,MD,FAAPAssistantProfessorofPediatrics,UniformedServicesUniversityoftheHealth
SciencesAttendingPhysician,DivisionofPediatricInfectiousDiseases,DepartmentofPediatrics,TriplerArmy
MedicalCenter
Disclosure:Nothingtodisclose.
JuanDDiaz,DOFellowinInfectiousDiseases,UniversityofSouthFloridaCollegeofMedicine,TampaGeneral
Hospital,andJamesAHaleyVeteransHospital
Disclosure:Nothingtodisclose.
JosephDomachowske,MDProfessorofPediatrics,MicrobiologyandImmunology,DepartmentofPediatrics,
DivisionofInfectiousDiseases,StateUniversityofNewYorkUpstateMedicalUniversity
JosephDomachowske,MDisamemberofthefollowingmedicalsocieties:AlphaOmegaAlpha,American
AcademyofPediatrics,AmericanSocietyforMicrobiology,InfectiousDiseasesSocietyofAmerica,Pediatric
InfectiousDiseasesSociety,andPhiBetaKappa
Disclosure:Nothingtodisclose.
PatrickWHickey,MD,FAAPAssistantProfessorofPediatricsandPreventiveMedicine,UniformedServices
UniversityoftheHealthSciencesConsultingStaff,DepartmentofPediatrics,DivisionofPediatricInfectious
Disease,WalterReedArmyMedicalCenter

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PatrickWHickey,MD,FAAPisamemberofthefollowingmedicalsocieties:AlphaOmegaAlpha,American
AcademyofPediatrics,AmericanSocietyofTropicalMedicineandHygiene,InfectiousDiseasesSocietyof
America,InternationalSocietyofTravelMedicine,andPediatricInfectiousDiseasesSociety
Disclosure:Nothingtodisclose.
EdmondAHookerII,MD,DrPH,FAAEMAssistantProfessor,DepartmentofEmergencyMedicine,University
ofCincinnatiCollegeofMedicineAssociateProfessor,DepartmentofHealthServicesAdministration,Xavier
University
EdmondAHookerII,MD,DrPH,FAAEMisamemberofthefollowingmedicalsocieties:AmericanAcademyof
EmergencyMedicine,AmericanPublicHealthAssociation,SocietyforAcademicEmergencyMedicine,and
SouthernMedicalAssociation
Disclosure:Nothingtodisclose.
MatthewRJezior,MDFellow,DepartmentofCardiology,WalterReedMedicalCenter
Disclosure:Nothingtodisclose.
MariaDMileno,MDAssociateProfessorofMedicine,DivisionofInfectiousDiseases,TheWarrenAlpert
MedicalSchoolofBrownUniversity
MariaDMileno,MDisamemberofthefollowingmedicalsocieties:AlphaOmegaAlpha,AmericanCollegeof
Physicians,AmericanSocietyofTropicalMedicineandHygiene,InfectiousDiseasesSocietyofAmerica,
InternationalSocietyofTravelMedicine,andSigmaXi
Disclosure:Nothingtodisclose.
JosephTMorris,MDChiefofInfectiousDiseaseService,MadiganArmyMedicalCenterAssistantProfessor,
DepartmentofInternalMedicine,UniformedServicesUniversityoftheHealthSciences
Disclosure:Nothingtodisclose.
GaryJNoel,MDProfessor,DepartmentofPediatrics,WeillCornellMedicalCollegeAttendingPediatrician,
NewYorkPresbyterianHospital
GaryJNoel,MDisamemberofthefollowingmedicalsocieties:PediatricInfectiousDiseasesSociety
Disclosure:Nothingtodisclose.
CecilyKPeterson,MDProgramDirector,ClinicalFaculty,DepartmentofMedicine,MadiganArmyMedical
Center
Disclosure:Nothingtodisclose.
CharlesVSanders,MDEdgarHullProfessorandChairman,DepartmentofInternalMedicine,Professorof
Microbiology,ImmunologyandParasitology,LouisianaStateUniversitySchoolofMedicineatNewOrleans
MedicalDirector,MedicineHospitalCenter,CharityHospitalandMedicalCenterofLouisianaatNewOrleans
ConsultingStaff,OchsnerMedicalCenter
CharlesVSanders,MDisamemberofthefollowingmedicalsocieties:AllianceforthePrudentUseof
Antibiotics,AlphaOmegaAlpha,AmericanAssociationfortheAdvancementofScience,AmericanAssociation
ofUniversityProfessors,AmericanClinicalandClimatologicalAssociation,AmericanCollegeofPhysician
Executives,AmericanCollegeofPhysicians,AmericanFederationforMedicalResearch,AmericanFoundation
forAIDSResearch,AmericanGeriatricsSociety,AmericanLungAssociation,AmericanMedicalAssociation,
AmericanSocietyforMicrobiology,AmericanThoracicSociety,AmericanVenerealDiseaseAssociation,
AssociationforProfessionalsinInfectionControlandEpidemiology,AssociationofAmericanMedicalColleges,
AssociationofAmericanPhysicians,AssociationofProfessorsofMedicine,InfectiousDiseaseSocietyfor
ObstetricsandGynecology,InfectiousDiseasesSocietyofAmerica,LouisianaStateMedicalSociety,Orleans
ParishMedicalSociety,RoyalSocietyofMedicine,SigmaXi,SocietyofGeneralInternalMedicine,
SoutheasternClinicalClub,SouthernMedicalAssociation,SouthernSocietyforClinicalInvestigation,and
SouthwesternAssociationofClinicalMicrobiology
Disclosure:Nothingtodisclose.
WilliamHShoff,MD,DTM&HDirector,PENNTravelMedicineAssociateProfessor,DepartmentofEmergency
Medicine,HospitaloftheUniversityofPennsylvania,UniversityofPennsylvaniaSchoolofMedicine
WilliamHShoff,MD,DTM&Hisamemberofthefollowingmedicalsocieties:AmericanCollegeofPhysicians,
AmericanSocietyofTropicalMedicineandHygiene,InternationalSocietyofTravelMedicine,Societyfor
AcademicEmergencyMedicine,andWildernessMedicalSociety
Disclosure:Nothingtodisclose.
RussellWSteele,MDHead,DivisionofPediatricInfectiousDiseases,OchsnerChildren'sHealthCenter
ClinicalProfessor,DepartmentofPediatrics,TulaneUniversitySchoolofMedicine
RussellWSteele,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofPediatrics,
AmericanAssociationofImmunologists,AmericanPediatricSociety,AmericanSocietyforMicrobiology,
InfectiousDiseasesSocietyofAmerica,LouisianaStateMedicalSociety,PediatricInfectiousDiseasesSociety,
SocietyforPediatricResearch,andSouthernMedicalAssociation
Disclosure:Nothingtodisclose.
FranciscoTalavera,PharmD,PhDAdjunctAssistantProfessor,UniversityofNebraskaMedicalCenterCollege
ofPharmacyEditorinChief,MedscapeDrugReference
Disclosure:MedscapeSalaryEmployment
Jeter(Jay)PritchardTaylorIII,MDComplianceOfficer,AttendingPhysician,EmergencyMedicineResidency,
DepartmentofEmergencyMedicine,PalmettoHealthRichland,UniversityofSouthCarolinaSchoolofMedicine
MedicalDirector,DepartmentofEmergencyMedicine,PalmettoHealthBaptist
Jeter(Jay)PritchardTaylorIII,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyof
EmergencyMedicine,AmericanCollegeofEmergencyPhysicians,AmericanMedicalAssociation,andSociety
forAcademicEmergencyMedicine
Disclosure:Nothingtodisclose.
MaryLWindle,PharmDAdjunctAssociateProfessor,UniversityofNebraskaMedicalCenterCollegeof

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PharmacyEditorinChief,MedscapeDrugReference
Disclosure:Nothingtodisclose.

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