What are the treatment options for leptospirosis?

Updated: Jul 08, 2021
  • Author: Sandra G Gompf, MD, FACP, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Antibiotic therapy in the treatment of mild leptospirosis is typically unnecessary, since it is often self-limited, and most cases resolve without medical attention. Oral antibiotics shorten the course of illness and, perhaps most importantly, reduce and shorten urinary excretion of leptospires. Prophylaxis may be used in the setting of epidemics. If used, antibiotic treatment may include the following:

  • Doxycycline
  • Ampicillin or amoxicillin
  • Azithromycin or clarithromycin
  • Fluoroquinolone such as ciprofloxacin or levofloxacin

Antibiotics for leptospirosis requiring hospitalization include the following:

  • Intravenous penicillin G
  • Intravenous third-generation cephalosporins (cefotaxime and ceftriaxone)
  • Intravenous ampicillin or amoxicillin (second-line agents)
  • Intravenous erythromycin (in penicillin-allergic pregnant women)

Patients with severe cases of leptospirosis also require supportive therapy and careful management of renal, hepatic, hematologic, and central nervous system complications. If renal failure ensues, early initiation of hemodialysis or peritoneal dialysis may reduce mortality by nearly two-thirds. Additional supportive care may include inotropic agents, diuretics, or ophthalmic drops.

See Treatment and Medication for more detail.


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