Relapsing fever medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maliha Shakil, M.D. [2] Roghayeh Marandi

Overview

Antimicrobial therapy for relapsing fever in adults depends on the vector (Tick-borne vs. Louse-borne) and includes either Doxycycline, Erythromycin, or Tetracyclines. Intravenous Ceftriaxone is added if either meningitis or encephalitis is present.

Medical Therapy

Antimicrobial Medications

Antimicrobial regimen

Tick-Borne Relapsing Fever

  • Preferred regimen: Doxycycline 100 mg PO bid for 5-10 days[1]
  • Alternative regimen: Erythromycin 500 mg PO qid for 5-10 days
  • Note: If meningitis/encephalitis present, use Ceftriaxone 2 g IV q12h for 14 days

Louse-Borne Relapsing Fever

Additional aspects of management

When initiating antibiotic therapy, a patient should be watched closely for a Jarisch-Herxheimer reaction for the first 4 hours after the antibiotic is given. The reaction may be difficult to distinguish from a febrile crisis, with rigors and decreased blood pressure. Cooling blankets and appropriate use of antipyretic agents may be indicated and may be lessened by giving acetaminophen 650 mg orally 2 hours before and 2 hours after the first dose of antibiotic therapy. This reaction tends to be more severe in patients with louse-borne relapsing fever treated with penicillin.

References

  1. Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.