infectious diseases
Tularemia
Treatment of Tularemia
Streptomycin(pluschloramphenicolfor meningitis) Thepreferred drugis Streptomycin1 g IM every 12 hours for adults and 15 mg/kg IM every 12 hours for children for 7 to 10 days for moderate to severe disease Chloramphenicol12.5 to 25 mg/kg IV every 6 hours ordoxycycline100 mg orally 2 times a day for 14 to 21 days is added if there is evidence of meningitis. Alternatives tostreptomycininclude the following: Gentamicin1 to 2 mg/kg IM or IV every 8 hours (for moderate to severe disease) Doxycycline100 mg orally every 12 hours (for mild disease) Chloramphenicol12.5 to 25 mg/kg IV every 6 hours (used only for meningitis because there are more effective and safer alternatives) Ciprofloxacin500 mg orally every 12 hours (for mild disease) In a mass casualty setting if parenteral treatment is not feasible, oraldoxycyclineorciprofloxacinmay be used for adults and children. However, relapses occasionally occur with all of these drugs, and they may not prevent node suppuration. Continuous wet saline dressings are beneficial for primary skin lesions and may diminish the severity of lymphangitis and lymphadenitis. Surgical drainage of large abscesses is rarely necessary unless therapy is delayed. Inocular tularemia,applying warm saline compresses and using dark glasses give some relief. In severe cases, 2% homatropine 1 to 2 drops every 4 hours may relieve symptoms. Intense headache usually responds to oral analgesics. 