Treatment of Rocky Mountain spotted fever
- Daniel J Sexton, MD
Daniel J Sexton, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine
- Duke University Medical Center
- Micah T McClain, MD
Micah T McClain, MD
- Associate Professor of Medicine
- Division of Infectious Diseases
- Duke University Medical Center
Rocky Mountain spotted fever (RMSF) is a potentially lethal, but usually curable, tick-borne disease. It occurs throughout the United States, Canada, Mexico, Central America, and in parts of South America. The etiologic agent, Rickettsia rickettsii, is a gram-negative, obligate intracellular bacterium that causes a wide spectrum of clinical disease from mild to fulminant infection. Mortality from RMSF declined markedly in the last decade from 2.2 percent in 2000 to 0.3 percent in 2007, and has been essentially unchanged since that time [1,2].
The treatment of RMSF will be reviewed here. The basic biology of R. rickettsii, and the epidemiology, clinical manifestations, and diagnosis of RMSF are discussed separately. (See "Biology of Rickettsia rickettsii infection" and "Clinical manifestations and diagnosis of Rocky Mountain spotted fever".)
Our approach to treatment depends upon the certainty of disease and the severity of symptoms. Empiric therapy with doxycycline should be started if the diagnosis of Rocky Mountain spotted fever (RMSF) is suspected, even if the symptoms are mild.
Assessing likelihood of RMSF — A diagnosis of RMSF is likely in patients who present with fever, headache, and constitutional symptoms in the spring and summer months if:
●They are from an endemic area (see "Clinical manifestations and diagnosis of Rocky Mountain spotted fever", section on 'Epidemiology')
Subscribers log in hereLiterature review current through: Oct 2017. | This topic last updated: Sep 12, 2017.References
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- Assessing likelihood of RMSF
- Patients likely to have RMSF
- If the diagnosis is unlikely
- Importance of early therapy
- CHOICE OF ANTIBIOTIC
- Doxycycline as preferred agent
- - Non-pregnant adults
- - Pregnant women
- - Children
- Alternative agent
- Drug toxicity
- - Doxycycline
- - Chloramphenicol
- RESPONSE TO THERAPY
- DURATION OF TREATMENT
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS