Materiały źródłowe

• #1 Leptospirosis: Treatment and prevention – UpToDate

  https://www.uptodate.com/contents/leptospirosis-treatment-and-prevention

  Leptospirosis: Treatment and prevention […] The treatment and prevention of leptospirosis will be presented here. […] TREATMENT […] Supportive care — In the setting of severe illness due to leptospirosis, supportive care with renal replacement therapy, ventilatory support, and blood products may also be required. In general, such management is the same as organ failure due to other causes of sepsis. […] Antimicrobial therapy […] Clinical approach […] General principles — Most cases of leptospirosis are self-limited in the absence of antimicrobial therapy; however, some patients do develop complications with significant morbidity and mortality. In general, if the illness is severe enough to come to clinical attention and the diagnosis is recognized, antibiotic therapy should be administered to shorten the duration of illness and reduce shedding of organisms in the urine. The approach varies with the clinical presentation.

• #2 Leptospirosis Treatment & Management: Approach Considerations, Diet and Activity, Transfer

  https://emedicine.medscape.com/article/220563-treatment

  Antimicrobial therapy is indicated for the severe form of leptospirosis, but its use is controversial for the mild form of leptospirosis. A Cochrane Review found insufficient evidence to advocate for or against the use of antibiotics in the therapy for leptospirosis. […] If antibiotics are used, they should be initiated as soon as the diagnosis of leptospirosis is considered and should be continued for a full course despite initial serologic results, because most patients are diagnosed only through acute and convalescent testing. Early treatment has been shown to offer the best clinical outcomes; results from controlled studies of treatment during the immune phase have yielded mixed results. […] Mild leptospirosis is treated with doxycycline, ampicillin, or amoxicillin. For severe leptospirosis, intravenous penicillin G has long been the drug of choice, although the third-generation cephalosporins cefotaxime and ceftriaxone have become widely used. Alternative regimens are ampicillin, amoxicillin, or erythromycin. Several other antibiotics may be useful; for example, broth microdilution testing has shown sensitivity to macrolides, fluoroquinolones, and carbapenems but clinical experience with these agents is more limited.

• #3 Leptospirosis Treatment & Management: Approach Considerations, Diet and Activity, Transfer

  https://emedicine.medscape.com/article/220563-treatment

  Antimicrobial therapy is indicated for the severe form of leptospirosis, but its use is controversial for the mild form of leptospirosis. A Cochrane Review found insufficient evidence to advocate for or against the use of antibiotics in the therapy for leptospirosis. […] If antibiotics are used, they should be initiated as soon as the diagnosis of leptospirosis is considered and should be continued for a full course despite initial serologic results, because most patients are diagnosed only through acute and convalescent testing. Early treatment has been shown to offer the best clinical outcomes; results from controlled studies of treatment during the immune phase have yielded mixed results. […] Mild leptospirosis is treated with doxycycline, ampicillin, or amoxicillin. For severe leptospirosis, intravenous penicillin G has long been the drug of choice, although the third-generation cephalosporins cefotaxime and ceftriaxone have become widely used. Alternative regimens are ampicillin, amoxicillin, or erythromycin. Several other antibiotics may be useful; for example, broth microdilution testing has shown sensitivity to macrolides, fluoroquinolones, and carbapenems but clinical experience with these agents is more limited.

• #4 Leptospirosis: Treatment and prevention – UpToDate

  https://www.uptodate.com/contents/leptospirosis-treatment-and-prevention

  Leptospirosis: Treatment and prevention […] The treatment and prevention of leptospirosis will be presented here. […] TREATMENT […] Supportive care — In the setting of severe illness due to leptospirosis, supportive care with renal replacement therapy, ventilatory support, and blood products may also be required. In general, such management is the same as organ failure due to other causes of sepsis. […] Antimicrobial therapy […] Clinical approach […] General principles — Most cases of leptospirosis are self-limited in the absence of antimicrobial therapy; however, some patients do develop complications with significant morbidity and mortality. In general, if the illness is severe enough to come to clinical attention and the diagnosis is recognized, antibiotic therapy should be administered to shorten the duration of illness and reduce shedding of organisms in the urine. The approach varies with the clinical presentation.

• #5 Leptospirosis: Treatment and prevention – UpToDate

  https://www.uptodate.com/contents/leptospirosis-treatment-and-prevention

  Mild disease — For outpatients with mild disease, we favor treatment with doxycycline (adults: 100 mg orally twice daily for 7 days; children: 2 mg/kg per day in two equally divided doses [not to exceed 200 mg daily] for 7 days) or azithromycin (adults: 500 mg orally once daily for three days; children: 10 mg/kg orally on day 1 [maximum dose 500 mg/day] followed by 5 mg/kg/day orally once daily on subsequent days [maximum dose 250 mg/day]). […] Severe disease — For hospitalized adults with severe disease, we favor treatment with penicillin (1.5 million units intravenously [IV] every six hours), doxycycline (100 mg IV twice daily), ceftriaxone (1 to 2 g IV once daily), or cefotaxime (1 g IV every six hours). The duration of treatment in severe disease is usually seven days. […] Efficacy — Whether antimicrobials produce a beneficial effect in leptospirosis remains unclear, mainly due to the paucity of clinical trial evidence in the disease.

• #6 Leptospirosis: Treatment and prevention – UpToDate

  https://www.uptodate.com/contents/leptospirosis-treatment-and-prevention/print

  For outpatients with mild disease, we favor treatment with doxycycline (adults: 100 mg orally twice daily for 7 days; children: 2 mg/kg per day in two equally divided doses [not to exceed 200 mg daily] for 7 days) or azithromycin (adults: 500 mg orally once daily for three days; children: 10 mg/kg orally on day 1 [maximum dose 500 mg/day] followed by 5 mg/kg/day orally once daily on subsequent days [maximum dose 250 mg/day]). […] For hospitalized adults with severe disease, we favor treatment with penicillin (1.5 million units intravenously [IV] every six hours), doxycycline (100 mg IV twice daily), ceftriaxone (1 to 2 g IV once daily), or cefotaxime (1 g IV every six hours). The duration of treatment in severe disease is usually seven days. […] For hospitalized children with severe disease, we favor treatment with penicillin (250,000 to 400,000 units/kg IV per day in four to six divided doses [maximum dose 6 to 12 million units daily]), doxycycline (4 mg/kg IV per day in two equally divided doses [maximum dose 200 mg/day]), ceftriaxone (80 to 100 mg/kg IV once daily [maximum dose 2 g daily]), or cefotaxime (100 to 150 mg/kg IV per day in three to four equally divided doses).

• #7 Leptospirosis Treatment & Management: Approach Considerations, Diet and Activity, Transfer

  https://emedicine.medscape.com/article/220563-treatment

  Antimicrobial therapy is indicated for the severe form of leptospirosis, but its use is controversial for the mild form of leptospirosis. A Cochrane Review found insufficient evidence to advocate for or against the use of antibiotics in the therapy for leptospirosis. […] If antibiotics are used, they should be initiated as soon as the diagnosis of leptospirosis is considered and should be continued for a full course despite initial serologic results, because most patients are diagnosed only through acute and convalescent testing. Early treatment has been shown to offer the best clinical outcomes; results from controlled studies of treatment during the immune phase have yielded mixed results. […] Mild leptospirosis is treated with doxycycline, ampicillin, or amoxicillin. For severe leptospirosis, intravenous penicillin G has long been the drug of choice, although the third-generation cephalosporins cefotaxime and ceftriaxone have become widely used. Alternative regimens are ampicillin, amoxicillin, or erythromycin. Several other antibiotics may be useful; for example, broth microdilution testing has shown sensitivity to macrolides, fluoroquinolones, and carbapenems but clinical experience with these agents is more limited.

• #8 Leptospirosis: Treatment and prevention – UpToDate

  https://www.uptodate.com/contents/leptospirosis-treatment-and-prevention

  Mild leptospirosis – We suggest administration of antimicrobial therapy for treatment of patients with mild leptospirosis. We favor treatment with oral doxycycline or oral azithromycin; these agents are also effective for rickettsial infections, which can be difficult to distinguish from leptospirosis. […] Severe leptospirosis – We recommend administration of antimicrobial therapy for treatment of patients with severe leptospirosis. Parenteral penicillin, doxycycline, and third-generation cephalosporins are all acceptable options. […] Prevention – There is no human vaccine widely available. Prevention measures include avoiding potential sources of infection, administration of prophylaxis for individuals at high risk of exposure, and animal vaccination. Prophylaxis with doxycycline is reasonable for individuals with high likelihood for exposure to leptospires in endemic environments over a defined period.

• #9 Leptospirosis: Treatment and prevention – UpToDate

  https://www.uptodate.com/contents/leptospirosis-treatment-and-prevention

  Mild disease — For outpatients with mild disease, we favor treatment with doxycycline (adults: 100 mg orally twice daily for 7 days; children: 2 mg/kg per day in two equally divided doses [not to exceed 200 mg daily] for 7 days) or azithromycin (adults: 500 mg orally once daily for three days; children: 10 mg/kg orally on day 1 [maximum dose 500 mg/day] followed by 5 mg/kg/day orally once daily on subsequent days [maximum dose 250 mg/day]). […] Severe disease — For hospitalized adults with severe disease, we favor treatment with penicillin (1.5 million units intravenously [IV] every six hours), doxycycline (100 mg IV twice daily), ceftriaxone (1 to 2 g IV once daily), or cefotaxime (1 g IV every six hours). The duration of treatment in severe disease is usually seven days. […] Efficacy — Whether antimicrobials produce a beneficial effect in leptospirosis remains unclear, mainly due to the paucity of clinical trial evidence in the disease.

• #10 Leptospirosis: Treatment and prevention – UpToDate

  https://www.uptodate.com/contents/leptospirosis-treatment-and-prevention/print

  For outpatients with mild disease, we favor treatment with doxycycline (adults: 100 mg orally twice daily for 7 days; children: 2 mg/kg per day in two equally divided doses [not to exceed 200 mg daily] for 7 days) or azithromycin (adults: 500 mg orally once daily for three days; children: 10 mg/kg orally on day 1 [maximum dose 500 mg/day] followed by 5 mg/kg/day orally once daily on subsequent days [maximum dose 250 mg/day]). […] For hospitalized adults with severe disease, we favor treatment with penicillin (1.5 million units intravenously [IV] every six hours), doxycycline (100 mg IV twice daily), ceftriaxone (1 to 2 g IV once daily), or cefotaxime (1 g IV every six hours). The duration of treatment in severe disease is usually seven days. […] For hospitalized children with severe disease, we favor treatment with penicillin (250,000 to 400,000 units/kg IV per day in four to six divided doses [maximum dose 6 to 12 million units daily]), doxycycline (4 mg/kg IV per day in two equally divided doses [maximum dose 200 mg/day]), ceftriaxone (80 to 100 mg/kg IV once daily [maximum dose 2 g daily]), or cefotaxime (100 to 150 mg/kg IV per day in three to four equally divided doses).

• #11 Leptospirosis: Treatment and prevention – UpToDate

  https://www.uptodate.com/contents/leptospirosis-treatment-and-prevention/print

  For outpatients with mild disease, we favor treatment with doxycycline (adults: 100 mg orally twice daily for 7 days; children: 2 mg/kg per day in two equally divided doses [not to exceed 200 mg daily] for 7 days) or azithromycin (adults: 500 mg orally once daily for three days; children: 10 mg/kg orally on day 1 [maximum dose 500 mg/day] followed by 5 mg/kg/day orally once daily on subsequent days [maximum dose 250 mg/day]). […] For hospitalized adults with severe disease, we favor treatment with penicillin (1.5 million units intravenously [IV] every six hours), doxycycline (100 mg IV twice daily), ceftriaxone (1 to 2 g IV once daily), or cefotaxime (1 g IV every six hours). The duration of treatment in severe disease is usually seven days. […] For hospitalized children with severe disease, we favor treatment with penicillin (250,000 to 400,000 units/kg IV per day in four to six divided doses [maximum dose 6 to 12 million units daily]), doxycycline (4 mg/kg IV per day in two equally divided doses [maximum dose 200 mg/day]), ceftriaxone (80 to 100 mg/kg IV once daily [maximum dose 2 g daily]), or cefotaxime (100 to 150 mg/kg IV per day in three to four equally divided doses).

• #12 Leptospirosis: Treatment and prevention – UpToDate

  https://www.uptodate.com/contents/leptospirosis-treatment-and-prevention/print

  Pregnant women with severe leptospirosis may be treated with penicillin, ceftriaxone, cefotaxime, or azithromycin. […] Whether antimicrobials produce a beneficial effect in leptospirosis remains unclear, mainly due to the paucity of clinical trial evidence in the disease. […] Use of intravenous corticosteroid therapy has been proposed given the vasculitic nature of severe leptospirosis, particularly in the setting of pulmonary involvement; thus far, there is insufficient evidence for routine use of corticosteroids. […] Plasmapheresis has also been used in severe leptospirosis and there is some nonrandomized evidence suggesting benefit, but there is no high-quality randomized evidence to justify routine use. […] Clinical approach – The majority of leptospirosis infections are self-limiting. Antimicrobial therapy shortens the duration of illness and reduces shedding of the organism in the urine.

• #13 Leptospirosis Treatment & Management: Approach Considerations, Diet and Activity, Transfer

  https://emedicine.medscape.com/article/220563-treatment

  Severe cases of leptospirosis can affect any organ system and can lead to multiorgan failure. Severe leptospirosis can have a case-fatality rate of over 50%, even with intensive care unit support. Thus, supportive therapy and careful management of renal, hepatic, hematologic, and central nervous system complications are important. […] Patients should be managed in a monitored setting because their condition can rapidly progress to cardiovascular collapse and shock. Access to mechanical ventilation and airway protection should be available in the event of respiratory compromise. Continuous cardiac monitoring should be attained; arrhythmias, including ventricular tachycardia and premature ventricular contractions, as well as atrial fibrillation, flutter, and tachycardia, can occur. […] Renal function should be evaluated carefully and dialysis considered in cases of renal failure. In most cases, the renal damage is reversible if the patient survives the acute illness. Early initiation of hemodialysis or peritoneal dialysis considerably reduces mortality risk. A few cases in the literature have reported that plasma exchange, corticosteroids, and intravenous immunoglobulin may be beneficial in selected patients in whom conventional therapy does not elicit a response.

• #14 Leptospirosis: Treatment and prevention – UpToDate

  https://www.uptodate.com/contents/leptospirosis-treatment-and-prevention/print

  Leptospirosis: Treatment and prevention […] The treatment and prevention of leptospirosis will be presented here. […] Supportive care — In the setting of severe illness due to leptospirosis, supportive care with renal replacement therapy, ventilatory support, and blood products may also be required. In general, such management is the same as organ failure due to other causes of sepsis. […] For patients with ARDS, low net fluid intake to prevent pulmonary hemorrhage and lung-protective ventilation practices are appropriate. Extracorporeal membrane oxygenation has been used successfully in cases of leptospirosis with severe pulmonary hemorrhage, though there is no randomized evidence supporting routine use. […] General principles — Most cases of leptospirosis are self-limited in the absence of antimicrobial therapy; however, some patients do develop complications with significant morbidity and mortality. In general, if the illness is severe enough to come to clinical attention and the diagnosis is recognized, antibiotic therapy should be administered to shorten the duration of illness and reduce shedding of organisms in the urine. The approach varies with the clinical presentation.

• #15 Leptospirosis Treatment & Management: Approach Considerations, Diet and Activity, Transfer

  https://emedicine.medscape.com/article/220563-treatment

  Severe cases of leptospirosis can affect any organ system and can lead to multiorgan failure. Severe leptospirosis can have a case-fatality rate of over 50%, even with intensive care unit support. Thus, supportive therapy and careful management of renal, hepatic, hematologic, and central nervous system complications are important. […] Patients should be managed in a monitored setting because their condition can rapidly progress to cardiovascular collapse and shock. Access to mechanical ventilation and airway protection should be available in the event of respiratory compromise. Continuous cardiac monitoring should be attained; arrhythmias, including ventricular tachycardia and premature ventricular contractions, as well as atrial fibrillation, flutter, and tachycardia, can occur. […] Renal function should be evaluated carefully and dialysis considered in cases of renal failure. In most cases, the renal damage is reversible if the patient survives the acute illness. Early initiation of hemodialysis or peritoneal dialysis considerably reduces mortality risk. A few cases in the literature have reported that plasma exchange, corticosteroids, and intravenous immunoglobulin may be beneficial in selected patients in whom conventional therapy does not elicit a response.

• #16 Leptospirosis: Treatment and prevention – UpToDate

  https://www.uptodate.com/contents/leptospirosis-treatment-and-prevention/print

  Leptospirosis: Treatment and prevention […] The treatment and prevention of leptospirosis will be presented here. […] Supportive care — In the setting of severe illness due to leptospirosis, supportive care with renal replacement therapy, ventilatory support, and blood products may also be required. In general, such management is the same as organ failure due to other causes of sepsis. […] For patients with ARDS, low net fluid intake to prevent pulmonary hemorrhage and lung-protective ventilation practices are appropriate. Extracorporeal membrane oxygenation has been used successfully in cases of leptospirosis with severe pulmonary hemorrhage, though there is no randomized evidence supporting routine use. […] General principles — Most cases of leptospirosis are self-limited in the absence of antimicrobial therapy; however, some patients do develop complications with significant morbidity and mortality. In general, if the illness is severe enough to come to clinical attention and the diagnosis is recognized, antibiotic therapy should be administered to shorten the duration of illness and reduce shedding of organisms in the urine. The approach varies with the clinical presentation.

• #17 Leptospirosis Treatment & Management: Approach Considerations, Diet and Activity, Transfer

  https://emedicine.medscape.com/article/220563-treatment

  Corticosteroid therapy is controversial. However, it might be beneficial in severe disease and/or cases with pulmonary involvement. Larger, prospective studies are needed for evidence-based recommendations. […] Treatment with high-dose pulsed methylprednisolone (30 mg/kg/d, not to exceed 1500 mg) has been used successfully to treat patients with leptospiral renal failure without dialysis. This approach may have been beneficial in resource-poor areas where dialysis is unavailable and would involve lengthy medical transport. The use of renal-dose dopamine in conjunction with steroids or diuretics has been described. […] Pulse-dose steroids may also play a role early in the management of severe pulmonary disease. […] Patients with Weil syndrome may need transfusions of whole blood, platelets, or both. Ophthalmic drops of mydriatics and corticosteroids have been used for relief of ocular symptoms.

• #18 Leptospirosis Treatment & Management: Approach Considerations, Diet and Activity, Transfer

  https://emedicine.medscape.com/article/220563-treatment

  Severe cases of leptospirosis can affect any organ system and can lead to multiorgan failure. Severe leptospirosis can have a case-fatality rate of over 50%, even with intensive care unit support. Thus, supportive therapy and careful management of renal, hepatic, hematologic, and central nervous system complications are important. […] Patients should be managed in a monitored setting because their condition can rapidly progress to cardiovascular collapse and shock. Access to mechanical ventilation and airway protection should be available in the event of respiratory compromise. Continuous cardiac monitoring should be attained; arrhythmias, including ventricular tachycardia and premature ventricular contractions, as well as atrial fibrillation, flutter, and tachycardia, can occur. […] Renal function should be evaluated carefully and dialysis considered in cases of renal failure. In most cases, the renal damage is reversible if the patient survives the acute illness. Early initiation of hemodialysis or peritoneal dialysis considerably reduces mortality risk. A few cases in the literature have reported that plasma exchange, corticosteroids, and intravenous immunoglobulin may be beneficial in selected patients in whom conventional therapy does not elicit a response.

• #19 Weil Disease: Symptoms, Causes & Treatment

  https://www.medicoverhospitals.in/diseases/weil-disease/

  Intravenous Fluids: IV fluids may be administered to prevent dehydration and maintain electrolyte balance in severe cases of Weil Disease. […] Supportive Care: Patients with Weil Disease may require supportive care, including rest, pain management, and monitoring for complications. […] Dialysis: In cases of kidney involvement, dialysis may be necessary to help filter waste from the blood and support kidney function. […] Hospitalization: Severe cases of Weil Disease may require hospitalization for close monitoring, intensive treatment, and management of potential complications.

• #20 Leptospirosis Treatment & Management: Approach Considerations, Diet and Activity, Transfer

  https://emedicine.medscape.com/article/220563-treatment

  Corticosteroid therapy is controversial. However, it might be beneficial in severe disease and/or cases with pulmonary involvement. Larger, prospective studies are needed for evidence-based recommendations. […] Treatment with high-dose pulsed methylprednisolone (30 mg/kg/d, not to exceed 1500 mg) has been used successfully to treat patients with leptospiral renal failure without dialysis. This approach may have been beneficial in resource-poor areas where dialysis is unavailable and would involve lengthy medical transport. The use of renal-dose dopamine in conjunction with steroids or diuretics has been described. […] Pulse-dose steroids may also play a role early in the management of severe pulmonary disease. […] Patients with Weil syndrome may need transfusions of whole blood, platelets, or both. Ophthalmic drops of mydriatics and corticosteroids have been used for relief of ocular symptoms.

• #21 Corticosteroid Treatment for Leptospirosis: A Systematic Review and Meta-Analysis

  https://www.mdpi.com/2077-0383/13/15/4310

  Corticosteroids are considered for potentially reducing the frequency or intensity of the Jarisch–Herxheimer reaction. […] The role of corticosteroids in treating severe leptospirosis, especially in addressing pulmonary complications like ARDS, has been explored in a limited number of studies. […] The findings indicate that corticosteroid use in leptospirosis is associated with a risk of nosocomial infections, which further complicates the assessment of their overall benefit. […] Given the parallels in the immune response mechanisms between leptospirosis and other severe acute respiratory diseases like COVID-19, where corticosteroids have shown favorable outcomes, there is a rationale for continued investigation into their use for leptospirosis. […] This meta-analysis is the first to explore the efficacy of corticosteroids in treating severe leptospirosis, including Weil’s disease and ARDS. Despite some studies suggesting potential benefits, particularly for pulmonary complications, the evidence remains inconclusive due to the limited number of studies and their methodological limitations.

• #22 Leptospirosis Treatment & Management: Approach Considerations, Diet and Activity, Transfer

  https://emedicine.medscape.com/article/220563-treatment

  Corticosteroid therapy is controversial. However, it might be beneficial in severe disease and/or cases with pulmonary involvement. Larger, prospective studies are needed for evidence-based recommendations. […] Treatment with high-dose pulsed methylprednisolone (30 mg/kg/d, not to exceed 1500 mg) has been used successfully to treat patients with leptospiral renal failure without dialysis. This approach may have been beneficial in resource-poor areas where dialysis is unavailable and would involve lengthy medical transport. The use of renal-dose dopamine in conjunction with steroids or diuretics has been described. […] Pulse-dose steroids may also play a role early in the management of severe pulmonary disease. […] Patients with Weil syndrome may need transfusions of whole blood, platelets, or both. Ophthalmic drops of mydriatics and corticosteroids have been used for relief of ocular symptoms.

• #23 Leptospirosis Medication: Antibiotics, Corticosteroids

  https://emedicine.medscape.com/article/220563-medication

  Treatment for leptospirosis consists of empiric antibiotic therapy. In general, antibiotic therapy should be effective against leptospirosis and against the other pathogens considered in the differential diagnoses. If renal failure ensues, corticosteroids may be considered. Additional supportive care may include inotropic agents, diuretics, or ophthalmic drops. No human vaccine against leptospirosis is available. […] For severe leptospirosis, intravenous penicillin G has long been considered the drug of choice. Doxycycline is used for the treatment of mild leptospirosis. Ampicillin or amoxicillin are alternatives for the treatment of mild leptospirosis. Erythromycin is the therapy of choice in pregnant patients who are allergic to penicillin. Third-generation cephalosporins have become widely used for intravenous antibiotic treatment in patients with severe leptospirosis. […] In patients with leptospirosis, corticosteroids are indicated to improve renal failure outcome. […] High-dose pulsed methylprednisolone (30 mg/kg/d, not to exceed 1500 mg) has been used successfully to treat patients with leptospiral renal failure without dialysis.

• #24 Leptospirosis Treatment & Management: Approach Considerations, Diet and Activity, Transfer

  https://emedicine.medscape.com/article/220563-treatment

  Corticosteroid therapy is controversial. However, it might be beneficial in severe disease and/or cases with pulmonary involvement. Larger, prospective studies are needed for evidence-based recommendations. […] Treatment with high-dose pulsed methylprednisolone (30 mg/kg/d, not to exceed 1500 mg) has been used successfully to treat patients with leptospiral renal failure without dialysis. This approach may have been beneficial in resource-poor areas where dialysis is unavailable and would involve lengthy medical transport. The use of renal-dose dopamine in conjunction with steroids or diuretics has been described. […] Pulse-dose steroids may also play a role early in the management of severe pulmonary disease. […] Patients with Weil syndrome may need transfusions of whole blood, platelets, or both. Ophthalmic drops of mydriatics and corticosteroids have been used for relief of ocular symptoms.

• #25 Leptospirosis: Treatment and prevention – UpToDate

  https://www.uptodate.com/contents/leptospirosis-treatment-and-prevention

  Role of corticosteroids and plasmapheresis — Use of intravenous corticosteroid therapy has been proposed given the vasculitic nature of severe leptospirosis, particularly in the setting of pulmonary involvement; thus far, there is insufficient evidence for routine use of corticosteroids. […] PREVENTION — Several human vaccines have been developed; all are serovar specific, developed for specific epidemiologic circumstances. None is widely available. Prevention measures include avoiding potential sources of infection, administration of prophylaxis for individuals at high risk of exposure, and animal vaccination. […] SUMMARY AND RECOMMENDATIONS […] Clinical approach – The majority of leptospirosis infections are self-limiting. Antimicrobial therapy shortens the duration of illness and reduces shedding of the organism in the urine.

• #26 Leptospirosis: An important zoonosis acquired through work, play and travel

  https://www1.racgp.org.au/ajgp/2018/march/leptospirosis

  Depending on the complications, management might include intravenous fluids and inotropes, ventilation, haemodialysis, and treatment of arrhythmias and coagulopathies. Currently, corticosteroids are not recommended because there is conflicting evidence about their effectiveness, and their use has been associated with increased risk of nosocomial infections in patients with severe leptospirosis. […] Doxycycline has been considered for prophylaxis, but a systematic review concluded that regular use at 200 mg weekly was associated with nausea and vomiting, and there was no clear benefit for reducing the risk of leptospirosis. Routine use is therefore not recommended, but might be considered if short-term intense exposures are anticipated (eg soldiers, outbreak response personnel, recreational exposure) or after high-risk exposures (eg floodwaters).

• #27 Leptospirosis Treatment & Management: Approach Considerations, Diet and Activity, Transfer

  https://emedicine.medscape.com/article/220563-treatment

  Severe cases of leptospirosis can affect any organ system and can lead to multiorgan failure. Severe leptospirosis can have a case-fatality rate of over 50%, even with intensive care unit support. Thus, supportive therapy and careful management of renal, hepatic, hematologic, and central nervous system complications are important. […] Patients should be managed in a monitored setting because their condition can rapidly progress to cardiovascular collapse and shock. Access to mechanical ventilation and airway protection should be available in the event of respiratory compromise. Continuous cardiac monitoring should be attained; arrhythmias, including ventricular tachycardia and premature ventricular contractions, as well as atrial fibrillation, flutter, and tachycardia, can occur. […] Renal function should be evaluated carefully and dialysis considered in cases of renal failure. In most cases, the renal damage is reversible if the patient survives the acute illness. Early initiation of hemodialysis or peritoneal dialysis considerably reduces mortality risk. A few cases in the literature have reported that plasma exchange, corticosteroids, and intravenous immunoglobulin may be beneficial in selected patients in whom conventional therapy does not elicit a response.

• #28 Leptospirosis: Treatment and prevention – UpToDate

  https://www.uptodate.com/contents/leptospirosis-treatment-and-prevention/print

  Pregnant women with severe leptospirosis may be treated with penicillin, ceftriaxone, cefotaxime, or azithromycin. […] Whether antimicrobials produce a beneficial effect in leptospirosis remains unclear, mainly due to the paucity of clinical trial evidence in the disease. […] Use of intravenous corticosteroid therapy has been proposed given the vasculitic nature of severe leptospirosis, particularly in the setting of pulmonary involvement; thus far, there is insufficient evidence for routine use of corticosteroids. […] Plasmapheresis has also been used in severe leptospirosis and there is some nonrandomized evidence suggesting benefit, but there is no high-quality randomized evidence to justify routine use. […] Clinical approach – The majority of leptospirosis infections are self-limiting. Antimicrobial therapy shortens the duration of illness and reduces shedding of the organism in the urine.

• #29 Leptospirosis | Yellow Book | CDC

  https://wwwnc.cdc.gov/travel/yellowbook/2024/infections-diseases/leptospirosis

  If leptospirosis is suspected, initiate antimicrobial therapy as soon as possible, without waiting for diagnostic test results. Early treatment can be effective in decreasing the severity and duration of infection. For patients with mild symptoms, doxycycline is a drug of choice, unless contraindicated; alternative options include ampicillin, amoxicillin, or azithromycin. Intravenous penicillin is the drug of choice for patients with severe leptospirosis; ceftriaxone and cefotaxime are alternative antimicrobial agents. As with other spirochetal diseases, antibiotic treatment of patients with leptospirosis might cause a Jarisch-Herxheimer reaction, an acute febrile reaction frequently accompanied by headache, myalgia, and fever that can occur within the first 24 hours after the initiation of antibiotic treatment. The reaction is rarely fatal. Patients with severe leptospirosis might require hospitalization and supportive therapy, including intravenous hydration and electrolyte supplementation, dialysis in cases of oliguric renal failure, and mechanical ventilation in cases of respiratory failure.

• #30 Leptospirosis

  https://dermnetnz.org/topics/leptospirosis

  Severe cases are usually treated with intravenous benzylpenicillin. Supportive therapy such as renal dialysis and mechanical ventilation may also be required. Less severe cases are treated with oral antibiotics such as doxycycline or amoxicillin. Third-generation cephalosporins and quinolone antibiotics may also be effective. […] A Jarisch-Herxheimer reaction may occur after the start of antibiotic therapy. This is a clinical deterioration due to the release of toxins when large numbers of organisms are killed by antibiotics.

• #31 Leptospirosis – Infections – MSD Manual Consumer Version

  https://www.msdmanuals.com/home/infections/bacterial-infections-spirochetes/leptospirosis

  Infections are treated with antibiotics and, if severe, sometimes with fluids given intravenously and dialysis. […] For mild infections are treated with antibiotics, such as amoxicillin, ampicillin, and doxycycline, given by mouth. […] For severe infections, antibiotics such as penicillin, ampicillin, or ceftriaxone are given by vein (intravenously). Fluids containing salts may also be given. […] People with severe infection (Weil syndrome) may need blood transfusions and, if they have kidney failure, they may need hemodialysis. […] Within 2 hours after the first dose of the antibiotic, an uncomfortable reaction called Jarisch-Herxheimer reaction may occur, causing sweating, shaking chills, fever, and a fall in blood pressure. To reduce the severity of this reaction, doctors may give people acetaminophen before and after the first dose of the antibiotic.

• #32 Leptospirosis: Treatment and prevention – UpToDate

  https://www.uptodate.com/contents/leptospirosis-treatment-and-prevention

  Role of corticosteroids and plasmapheresis — Use of intravenous corticosteroid therapy has been proposed given the vasculitic nature of severe leptospirosis, particularly in the setting of pulmonary involvement; thus far, there is insufficient evidence for routine use of corticosteroids. […] PREVENTION — Several human vaccines have been developed; all are serovar specific, developed for specific epidemiologic circumstances. None is widely available. Prevention measures include avoiding potential sources of infection, administration of prophylaxis for individuals at high risk of exposure, and animal vaccination. […] SUMMARY AND RECOMMENDATIONS […] Clinical approach – The majority of leptospirosis infections are self-limiting. Antimicrobial therapy shortens the duration of illness and reduces shedding of the organism in the urine.

• #33 Leptospirosis: Treatment and prevention – UpToDate

  https://www.uptodate.com/contents/leptospirosis-treatment-and-prevention

  Mild leptospirosis – We suggest administration of antimicrobial therapy for treatment of patients with mild leptospirosis. We favor treatment with oral doxycycline or oral azithromycin; these agents are also effective for rickettsial infections, which can be difficult to distinguish from leptospirosis. […] Severe leptospirosis – We recommend administration of antimicrobial therapy for treatment of patients with severe leptospirosis. Parenteral penicillin, doxycycline, and third-generation cephalosporins are all acceptable options. […] Prevention – There is no human vaccine widely available. Prevention measures include avoiding potential sources of infection, administration of prophylaxis for individuals at high risk of exposure, and animal vaccination. Prophylaxis with doxycycline is reasonable for individuals with high likelihood for exposure to leptospires in endemic environments over a defined period.

• #34 Current treatment options for leptospirosis: a mini-review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11081000/

  Currently, the process of vaccine production for human vaccination is undergoing significant progress. Some countries, including Japan, Cuba, France and China, have tested human vaccines. These vaccines have been licensed for use in related countries. […] The development of a highly efficient vaccine for leptospirosis continues to be a challenge. The pathogen has developed strategies to avoid the defensive role of the complement system, replicate in the bloodstream, attach to host cells, and infiltrate organs and tissues more rapidly. […] Effective treatment strategies for leptospirosis are multifaceted, ranging from antibiotic therapy to emerging options such as probiotics and novel compounds. Antibiotics such as doxycycline remain the cornerstone of treatment, with recommendations tailored to the severity of infection. Probiotics show promise in modulating the gut microbiota and augmenting immune responses, although further research is needed to delineate their precise role in leptospirosis management. Additionally, the exploration of bacteriophages and novel compounds presents exciting avenues for future therapeutic interventions. Continued efforts to enhance our understanding of leptospirosis pathogenesis and treatment modalities are crucial for mitigating the impact of this pervasive zoonotic disease on global health.

• #35 Leptospirosis Causes, Symptoms, Diagnosis, Treatment, Vaccine

  https://www.medicinenet.com/leptospirosis/article.htm

  Leptospirosis is an infectious disease typically treated with antibiotics. […] Although there is controversy about using antibiotics in the first phase of leptospirosis, antibiotics (penicillin – penicillin G, ampicillin, amoxicillin, or erythromycin) are recommended for treatment of patients with phase two or more severe symptoms. Some patients may require IV antibiotics and supportive hospital care such as rehydration. […] For those clinicians who choose to treat phase-one patients, the choice of antibiotics includes the above, but many choose to treat with doxycycline. […] Overall, the prognosis of leptospirosis is good. Many people become infected and spontaneously recover without treatment. However, the prognosis worsens as the symptoms increase. People with Weil’s disease may have a prognosis ranging from good to poor, depending on their response to treatment. Pregnant women who become infected have a high rate of fetal mortality, especially if they acquire the disease early in pregnancy.

• #36 Leptospirosis Treatment & Management: Approach Considerations, Diet and Activity, Transfer

  https://emedicine.medscape.com/article/220563-treatment

  Severe cases of leptospirosis can affect any organ system and can lead to multiorgan failure. Severe leptospirosis can have a case-fatality rate of over 50%, even with intensive care unit support. Thus, supportive therapy and careful management of renal, hepatic, hematologic, and central nervous system complications are important. […] Patients should be managed in a monitored setting because their condition can rapidly progress to cardiovascular collapse and shock. Access to mechanical ventilation and airway protection should be available in the event of respiratory compromise. Continuous cardiac monitoring should be attained; arrhythmias, including ventricular tachycardia and premature ventricular contractions, as well as atrial fibrillation, flutter, and tachycardia, can occur. […] Renal function should be evaluated carefully and dialysis considered in cases of renal failure. In most cases, the renal damage is reversible if the patient survives the acute illness. Early initiation of hemodialysis or peritoneal dialysis considerably reduces mortality risk. A few cases in the literature have reported that plasma exchange, corticosteroids, and intravenous immunoglobulin may be beneficial in selected patients in whom conventional therapy does not elicit a response.

• #37 Leptospirosis Causes, Symptoms, Diagnosis, Treatment, Vaccine

  https://www.medicinenet.com/leptospirosis/article.htm

  Leptospirosis is an infectious disease typically treated with antibiotics. […] Although there is controversy about using antibiotics in the first phase of leptospirosis, antibiotics (penicillin – penicillin G, ampicillin, amoxicillin, or erythromycin) are recommended for treatment of patients with phase two or more severe symptoms. Some patients may require IV antibiotics and supportive hospital care such as rehydration. […] For those clinicians who choose to treat phase-one patients, the choice of antibiotics includes the above, but many choose to treat with doxycycline. […] Overall, the prognosis of leptospirosis is good. Many people become infected and spontaneously recover without treatment. However, the prognosis worsens as the symptoms increase. People with Weil’s disease may have a prognosis ranging from good to poor, depending on their response to treatment. Pregnant women who become infected have a high rate of fetal mortality, especially if they acquire the disease early in pregnancy.

• #38 Weil’s Disease: Causes, Symptoms, and Treatments

  https://www.healthline.com/health/weils-disease

  If left untreated, Weils disease can lead to kidney failure, liver failure, or heart failure. In rare cases, it may result in death. […] Starting antibiotics quickly can greatly improve your chances of recovery. Your doctor may also prescribe other treatments to help manage potential complications.

• #39 Leptospirosis: Treatment, symptoms, and types

  https://www.medicalnewstoday.com/articles/246829

  With effective and timely treatment, leptospirosis is less likely to become severe. […] The best way to prevent infection by leptospirosis is to avoid contact with bodies of water in areas where leptospirosis is common. […] However, if activities that involve exposure to bodies of water are planned, the CDC say that a traveler can take an oral antibiotic called doxycycline once weekly to prevent infection by this bacteria. […] The prophylaxis should be started 1-2 days before the exposure to water is set to happen.

• #40 Leptospirosis Treatment & Management: Approach Considerations, Diet and Activity, Transfer

  https://emedicine.medscape.com/article/220563-treatment

  Patients with severe disease should remain hospitalized until adequate resolution of organ failure and clinical infection. Outpatient follow-up may include an assessment of renal function to ensure ongoing reversal of any damage. A cardiac assessment may be indicated in patients with symptoms suggestive of heart involvement.

• #41 Leptospirosis: Treatment, symptoms, and types

  https://www.medicalnewstoday.com/articles/246829

  Leptospirosis is a bacterial infection. […] For mild cases, the doctor may prescribe antibiotics, such as doxycycline or penicillin. […] Patients with severe leptospirosis will need to spend time in the hospital. They will receive antibiotics intravenously. […] Depending on which organs leptospirosis affects, the individual may need a ventilator to help them breathe. […] If it affects the kidneys, dialysis may be necessary. […] Intravenous fluids can provide hydration and essential nutrients. […] Hospital stays may range from a few weeks to several months. This mostly depends on how the patient responds to antibiotic treatment, and how severely the infection damages their organs. […] During pregnancy, leptospirosis can affect the fetus. Anyone who has the infection during pregnancy will need to spend time in the hospital for monitoring.

• #42 Current treatment options for leptospirosis: a mini-review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11081000/

  Currently, the process of vaccine production for human vaccination is undergoing significant progress. Some countries, including Japan, Cuba, France and China, have tested human vaccines. These vaccines have been licensed for use in related countries. […] The development of a highly efficient vaccine for leptospirosis continues to be a challenge. The pathogen has developed strategies to avoid the defensive role of the complement system, replicate in the bloodstream, attach to host cells, and infiltrate organs and tissues more rapidly. […] Effective treatment strategies for leptospirosis are multifaceted, ranging from antibiotic therapy to emerging options such as probiotics and novel compounds. Antibiotics such as doxycycline remain the cornerstone of treatment, with recommendations tailored to the severity of infection. Probiotics show promise in modulating the gut microbiota and augmenting immune responses, although further research is needed to delineate their precise role in leptospirosis management. Additionally, the exploration of bacteriophages and novel compounds presents exciting avenues for future therapeutic interventions. Continued efforts to enhance our understanding of leptospirosis pathogenesis and treatment modalities are crucial for mitigating the impact of this pervasive zoonotic disease on global health.

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