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SUBJECT: Medical

Therapeutics
Topic: Leptospirosis
Dr. (Report)
Date
CASE Lepto MAT: there is a rise in the titer.
J.N. a 20 year old male, single, Filipino, Roman
Catholic, presently residing in Paranaque, admitted at DIAGNOSIS: Leptospirosis
Medical Center Manila for the first time with a chief
complaint of fever. 8 days PTC- patient experience Table 164-1 Treatment and Chemoprophylaxis of
undocumented fever, associated with generalized body Leptospirosis
malaise, nausea, loss of apetite, and headache. Patient
self medicated with Bioflu which afforded temporary
relief. No consult and labs done. 6 days PTC- Purpose of Drug Regimen
Administration
persistence of above symptoms, with more pronounced
left leg pain, and bilateral eye redness, still no consult Treatment
done. 5 days PTA- patient condition improved was Mild leptospirosis Doxycycline, 100 mg orally bid
eating well, afebrile, more energetic. 3 days PTC- or
undocumented fever recurred, associated with tea Ampicillin, 500–750 mg orally
colored urine, nausea, loss of apetite and 2 episode of qid
vomiting. Few hours PTC- above symptoms persisted or
Amoxicillin, 500 mg orally qid
prompted consult hence admission.
Moderate/severe Penicillin G, 1.5 million units IV
Past Medical History leptospirosis qid
Non-asthmatic, with no known allergies, non- or
Ampicillin, 1 g IV qid or
diabetic, non hypertensive, with no known heart
Amoxicillin, 1 g IV qid or
disease. Hospitalized 10 years ago due to DHF. Ceftriaxone, 1 g IV once daily or
Cefotaxime, 1 g IV qid or
Personal and Social History Erythromycin, 500 mg IV qid
A 3rd year nursing student, who wave in Chemoprophylaxis Doxycycline, 200 mg orally
floodwater 3 weeks ago after a heavy downpour. Non once a week
smoker, non alcoholic beverage drinker.

ROS
Unremarkable Jawetz: Treatment of mild leptospirosis should be with oral
doxycycline, ampicillin, or amoxicillin. Treatment of moderate
Physical Examination or severe disease should be with intravenous penicillin or
ampicillin.
BP 130/90 HR 96 RR 22 38.9
(+) subconjunctival suffusion
(+) dry tongue and oral mucosa MY ASSESSMENT: Mild Leptospirosis
(+) tenderness of left thigh Harrisons: acute influenza-like illness, with fever, chills,
severe headache, nausea, vomiting, and myalgias. Muscle
pain, which especially affects the calves, back, and abdomen,
Laboratory Workups
is an important feature of leptospiral infection; most common
finding on physical examination is fever with conjunctival
CBC – WBC 13, 800 suffusion; less common findings include muscle tenderness
Hg 12.8
Hct 34 REPORTER’S OPINION: Moderate to Severe
Neutrophils Seg 80 Leptospirosis
LyMphocytes 32 Harrisons: Weil's syndrome, the most severe form of
Monocytes 2 leptospirosis, is characterized by jaundice, renal dysfunction,
Eosinophils 2 and hemorrhagic diathesis; by pulmonary involvement in
many cases
Urine
• yellow, clear, DRUG OF CHOICE
• (-) sugar,
Mild Leptospirosis: Doxycycline
• Specific gravity 1.020,
Moderate to Severe Leptospirosis: Penicillin G
• WBC 2-3,
• RBC too numerous to count, ALTERNATIVES
• No Cast,
• Na 137, Mild: I would recommend Amoxicillin because this is
• K 3.8, better absorbed by the GI tract
• BUN 28, Moderate to Severe: Based on the reporter’s sane
• Creatinine 2.20 criteris, I would recommend Ampicillin
MED THERA – Leptospirosis
Page 2 of 6

PRESCRIPTIONS

Mild
Computations

Judee Marie A. Malubay, MD Stock Dose: 100 mg capsule


Department of Internal Medicine Adult: 200 mg BID
Pediatric (> 8 years and <45 kg): 4
Ospital ng Maynila Medical Center mg/kg/day BID
Quirino Avenue, Manila Assuming 50 kg:
50 kg x 4 mg/kg = 200 mg/day (100 mg
BID)
Name: ___________________________ Age/Sex:
Nelson’s Pediatrics: treatment with penicillin
___________ or tetracycline (in children 9 yr of age or older)
should be instituted as soon as the diagnosis is
Address: __________________________ Date: suspected. Parenteral penicillin G (6–8 million
U/m2/day divided every 4 hr IV for 7 days) is
______________ recommended, with tetracycline (10–20
mg/kg/day divided every 6 hr PO or IV for 7
days) as an alternative for patients allergic to
penicillin. Oral amoxicillin is an alternative
therapy for children <9 years of age.

Doxycycline
(Doxicon)
100 mg/capsule
#14 capsules

Sig: Take one capsule with food every 12 hours for


7 days. Take with one full glass of water and remain
upright for 30 minutes. Do not take with dairy products.

Refill: none

Warning: Do not give to children less than 8 years old


and to pregnant women. GI irritation, toxicity, nausea,
vomiting, diarrhea and tooth discoloration

Judee Marie A. Malubay


Judee Marie A. Malubay
Lic # 0870098
MED THERA – Leptospirosis
Page 3 of 6

Computations

Judee Marie A. Malubay, MD Stock Dose:


Department of Internal Medicine Capsule: 250 mg, 500 mg
F
Ospital ng Maynila Medical Center o
Quirino Avenue, Manila r
t
e
Name: ___________________________ Age/Sex:
___________ S
y
r
Address: __________________________ Date: u
______________ p
:

2
5
0

m
Amoxicillin g
(Amoxil) /
500 mg/capsule
5
#28 capsules m
L

Sig:
(
Take one capsule every 6 hours with meals for 3
0
better absorption and to reduce GI discomfort.
m
Refill: none L
,
Warning: Nausea, vomiting, diarrhea, rash, pruritus,
urticaria 6
0

m
L

b
Judee Marie A. Malubay o
Judee Marie A. Malubay t
Lic # 0870098 t
l
e
)
Syrup: 125 mg/ 5 mL (30 mL, 60 mL bottle)
Pediatric drops: 125 mg/5 mL (10 mL bottle)
MED THERA – Leptospirosis
Page 4 of 6
Adult: 250-500 mg every 8 hours (for leptospirosis
every 6 hours)
Pediatric: Child: ≤10 yr: 125-250 mg every 8 hr; <40
kg: 20-40 mg/kg daily in divided doses every 8 hr. Max
dose: Infant <3 mth: 30 mg/kg daily in divided doses
every 12 hr.
Assuming 30 kg
30 kg x 20 mg/kg = 600 mg/day (every 6 hours for
leptospirosis)
150 mg x 5 mL/250 mg = 3 mL
every 6 hours
30 kg x 40 mg/kg = 1200 mg/day (every 6
hours for leptospirosis
300 mg x 5 mL/250 mg = 6 mL every 6 hours
MED THERA – Leptospirosis
Page 5 of 6
Moderate to Severe
Stock Dose: 1 MU/vial, 5 MU/vial
Adult: 0.6-4.8 g/day in 2-4 divided doses
via IM, slow IV inj or infusion, higher
Judee Marie A. Malubay, MD doses may be needed in more serious
Department of Internal Medicine infections. IV doses >1.2 g should be
Ospital ng Maynila Medical Center given at a rate of not >300 mg/minute.
Note: 0.6 g = 1 MU
Quirino Avenue, Manila
Pediatrics: 1 mth-12 yr: 100 mg/kg
daily in 4 divided doses. Infant 1-4 wk:
75 mg/kg daily in 3 divided doses.
Name: ___________________________ Age/Sex: Premature infant and neonate up to 7
___________ days old: 50 mg/kg daily in 2 divided
doses.
Assume: 12 y/o weighing 30 kg
Address: __________________________ Date: 30 kg x 100 mg/kg = 3000 mg per day
______________ (750 mg qid)
0.75 g x 1 vial/0.6 g = 1.25 vial

Nelson’s Pediatrics: treatment with


penicillin or tetracycline (in children 9 yr of
age or older) should be instituted as soon as
the diagnosis is suspected. Parenteral
penicillin G (6–8 million U/m2/day divided
every 4 hr IV for 7 days) is recommended,
Benzylpenicllin with tetracycline (10–20 mg/kg/day divided
every 6 hr PO or IV for 7 days) as an
(Pencarv) alternative for patients allergic to penicillin.
1 MU/vial Oral amoxicillin is an alternative therapy for
#42 vials children <9 years of age.

Sig: After negative pencillin skin test, administer


1.5 MU (1.5 vial) intravenously every 6 hours for 7 days.

Refill: none

Warning: Allergic reactions

Judee Marie A. Malubay


Judee Marie A. Malubay
Lic # 0870098

Computations
MED THERA – Leptospirosis
Page 6 of 6

Judee Marie A. Malubay, MD


Department of Internal Medicine
Computations
Ospital ng Maynila Medical Center
Quirino Avenue, Manila Stock Dose:
Capsule: 500 mg
Vial: 250 mg, 500 mg
Name: ___________________________ Age/Sex: Adult & Children >20 kg: 250-500 mg 6
hrly, <20 kg 100-200 mg/kg/day in
___________ divided doses 6 hrly.
Infant: >7 days 75 mg/kg/day in divided
Address: __________________________ Date: doses 8 hrly, <7 days 50 mg/kg/day in
______________ divided doses 12 hrly.
Assuming 10 kg child
10 kg x 100 mg/kg = 1000 kg/day (250
mg qid)
10 kg x 200 mg/kg = 2000 kg/day (500
mg qid)

Ampicillin
(Ampicin)
500 mg/vial
#28 vials

Sig: After negative skin test, administer 2 vials (1


g) intravenously every 6 hours for 7 days.

Refill: none

Warning: Hypersensitivity reactions, anaphylaxis,


superinfection

Judee Marie A. Malubay


Judee Marie A. Malubay
Lic # 0870098

This is adapted from Dr. Erika Tuazon’s report and


excerpts from Jawetz, Katzung (for the dosage of
penicillin), Harrison’s, Nelsons and MIMS.com Happy
studying! 