infectious diseases
Overview of Rickettsial and Related Infections
Treatment of Rickettsial and Related Infections
Tetracyclines Because diagnostic tests can take time and may be insensitive, antibiotics are usually begun presumptively to prevent significant deterioration, death, and prolonged recovery. (5 to 10 days, as used for rickettsial disease) can be used in children without causing tooth staining or weakening of tooth enamel ( Treatment reference ). Chloramphenicolis second-line treatment whendoxycyclinecannot be used. Oralchloramphenicolis not available in the United States, and IM administration is not effective.Chloramphenicolcan cause adverse hematologic effects, which require monitoring of blood indices. Both medications are rickettsiostatic, not rickettsicidal. Ciprofloxacinand other fluoroquinolonesare effective in vitro against certain rickettsiae, but very little clinical experience supports the use of fluoroquinolones for RMSF. Because severely ill patients with RMSF or epidemic typhus may have a marked increase in capillary permeability in later stages, IV fluids should be given cautiously to maintain blood pressure while avoiding worsening pulmonary and cerebral edema. 1.Todd SR, Dahlgren FS, Traeger MS, et al: No visible dental staining in children treated withdoxycyclinefor suspected Rocky Mountain Spotted Fever.J Pediatr166(5):1246-51, 2015. doi: 10.1016/j.jpeds.2015.02.015 