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==Overview==
==Overview==
The mainstay of therapy for Q fever is [[doxycycline]]. The chronic form is more difficult to treat and can require up to two years of treatment with [[doxycycline]] and [[Hydroxychloroquine]]. Q fever in pregnancy is especially difficult to treat because [[doxycycline]] is contraindicated in [[pregnancy]] and so preferred treatment is [[Trimethoprim/Sulfamethoxazole]].
The mainstay of therapy for Q fever is [[doxycycline]]. The [[chronic]] form of Q fever is more difficult to treat and can require up to two years of treatment with [[doxycycline]] and [[hydroxychloroquine]]. Q fever in pregnancy is especially difficult to treat because [[doxycycline]] is contraindicated in [[pregnancy]], so preferred treatment is [[Sulfamethoxazole-Trimethoprim|trimethoprim/sulfamethoxazole]].


==Medical Therapy==
==Medical Therapy==
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::::* Preferred Regimen: [[Doxycycline]] 100 mg PO bid for 14 days
::::* Preferred Regimen: [[Doxycycline]] 100 mg PO bid for 14 days
:::* 1.2 '''Children'''
:::* 1.2 '''Children'''
::::* 1.2.1 '''Children with age  ≥8 years'''
::::* 1.2.1 '''Children with age  ≥ 8 years'''
:::::* Preferred regimen: [[Doxycycline]] 2.2 mg/kg  PO bid for 14 days (maximum 100 mg per dose)
:::::* Preferred regimen: [[Doxycycline]] 2.2 mg/kg  PO bid for 14 days (maximum 100 mg per dose)
::::* 1.2.2  '''Children with age <8 years with high risk criteria'''
::::* 1.2.2  '''Children with age < 8 years with high risk criteria'''
:::::* Preferred regimen: [[Doxycycline]] 2.2 mg/kg PO bid for 14 days (maximum: 100 mg per dose)
:::::* Preferred regimen: [[Doxycycline]] 2.2 mg/kg PO bid for 14 days (maximum: 100 mg per dose)
::::* 1.2.3  '''Children with age <8 years with mild or uncomplicated illness'''
::::* 1.2.3  '''Children with age < 8 years with mild or uncomplicated illness'''
:::::* Preferred regimen: [[Doxycycline]] 2.2 mg/kg  PO bid for 5 days (maximum 100 mg per dose).  
:::::* Preferred regimen: [[Doxycycline]] 2.2 mg/kg  PO bid for 5 days (maximum 100 mg per dose).  
::::* 1.2.3  '''Children with age < 8 years with mild or uncomplicated illness,who remains febrile past 5 days of treatment'''
::::* 1.2.3  '''Children with age < 8 years with mild or uncomplicated illness who remain febrile past 5 days of treatment'''
:::::* Preferred regimen: [[Trimethoprim/Sulfamethoxazole]] 4-20 mg/kg  PO bid for 14 days (maximum: 800 mg per dose)
:::::* Preferred regimen: [[Trimethoprim/Sulfamethoxazole]] 4-20 mg/kg  PO bid for 14 days (maximum: 800 mg per dose)
:::* 1.3 '''Pregnant women'''
:::* 1.3 '''Pregnant women'''
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:::* 2.1 '''Endocarditis or vascular infection'''
:::* 2.1 '''Endocarditis or vascular infection'''
::::* Preferred regimen: [[Doxycycline]] 100 mg PO bid {{and}} [[Hydroxychloroquine]] 200 mg PO tid  for ≥18 months
::::* Preferred regimen: [[Doxycycline]] 100 mg PO bid {{and}} [[Hydroxychloroquine]] 200 mg PO tid  for ≥18 months
::::* Note: childern and pregnant women- consultation  Recommended
::::* Note: Consultation recommended for children and pregnant women.
:::* 2.2 '''Noncardiac organ disease'''
:::* 2.2 '''Noncardiac organ disease'''
::::* Preferred regimen: [[Doxycycline]] 100 mg PO bid {{and}} [[Hydroxychloroquine]] 200 mg PO tid  
::::* Preferred regimen: [[Doxycycline]] 100 mg PO bid {{and}} [[Hydroxychloroquine]] 200 mg PO tid  
::::* Note: childern and pregnant women- consultation  Recommended
::::* Note: Consultation recommended for children and pregnant women.
:::* 2.3 '''Postpartum with serologic profile for chronic Q fever'''
:::* 2.3 '''Postpartum with serologic profile for chronic Q fever'''
::::* Preferred regimen: [[Doxycycline]] 100 mg PO bid {{and}} [[Hydroxychloroquine]] 200 mg PO tid for 12 months
::::* Preferred regimen: [[Doxycycline]] 100 mg PO bid {{and}} [[Hydroxychloroquine]] 200 mg PO tid for 12 months
::::* Note (1): Women should only be treated postpartum if serologic titers remain elevated >12 months after delivery ([[immunoglobulin G]] phase I titer ≥1:1024). Women treated during [[pregnancy]] for acute Q fever should be monitored similarly to other patients who are at high risk for progression to chronic disease (e.g., serologic monitoring at 3, 6, 12, 18, and 24 months after delivery)
::::* Note (1): Women should only be treated postpartum if serologic titers remain elevated >12 months after delivery ([[immunoglobulin G]] phase I titer ≥1:1024). Women treated during [[pregnancy]] for acute Q fever should be monitored similarly to other patients who are at high risk for progression to [[chronic]] disease (e.g., serologic monitoring at 3, 6, 12, 18, and 24 months after delivery)
::::* Note (2): Post-Q fever fatigue syndrome- no current recommendation.
::::* Note (2): There is no current recommendation for Post-Q fever [[fatigue]] syndrome


==References==
==References==

Revision as of 18:48, 3 August 2017


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]

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Overview

The mainstay of therapy for Q fever is doxycycline. The chronic form of Q fever is more difficult to treat and can require up to two years of treatment with doxycycline and hydroxychloroquine. Q fever in pregnancy is especially difficult to treat because doxycycline is contraindicated in pregnancy, so preferred treatment is trimethoprim/sulfamethoxazole.

Medical Therapy

Antimicrobial Regimen

  • 1. Acute Q fever
  • 1.1 Adults
  • Preferred Regimen: Doxycycline 100 mg PO bid for 14 days
  • 1.2 Children
  • 1.2.1 Children with age ≥ 8 years
  • Preferred regimen: Doxycycline 2.2 mg/kg PO bid for 14 days (maximum 100 mg per dose)
  • 1.2.2 Children with age < 8 years with high risk criteria
  • Preferred regimen: Doxycycline 2.2 mg/kg PO bid for 14 days (maximum: 100 mg per dose)
  • 1.2.3 Children with age < 8 years with mild or uncomplicated illness
  • Preferred regimen: Doxycycline 2.2 mg/kg PO bid for 5 days (maximum 100 mg per dose).
  • 1.2.3 Children with age < 8 years with mild or uncomplicated illness who remain febrile past 5 days of treatment
  • 1.3 Pregnant women
  • 2. Chronic Q fever
  • 2.1 Endocarditis or vascular infection
  • Preferred regimen: Doxycycline 100 mg PO bid AND Hydroxychloroquine 200 mg PO tid for ≥18 months
  • Note: Consultation recommended for children and pregnant women.
  • 2.2 Noncardiac organ disease
  • Preferred regimen: Doxycycline 100 mg PO bid AND Hydroxychloroquine 200 mg PO tid
  • Note: Consultation recommended for children and pregnant women.
  • 2.3 Postpartum with serologic profile for chronic Q fever
  • Preferred regimen: Doxycycline 100 mg PO bid AND Hydroxychloroquine 200 mg PO tid for 12 months
  • Note (1): Women should only be treated postpartum if serologic titers remain elevated >12 months after delivery (immunoglobulin G phase I titer ≥1:1024). Women treated during pregnancy for acute Q fever should be monitored similarly to other patients who are at high risk for progression to chronic disease (e.g., serologic monitoring at 3, 6, 12, 18, and 24 months after delivery)
  • Note (2): There is no current recommendation for Post-Q fever fatigue syndrome

References

  1. ↑ "q fever".


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