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Treatment of Rocky Mountain spotted fever

Daniel J Sexton, MD
Micah T McClain, MD
Section Editor
Stephen B Calderwood, MD
Deputy Editor
Jennifer Mitty, MD, MPH


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')

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Literature review current through: Nov 2017. | This topic last updated: Sep 12, 2017.
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