Treatment of<i>Rickettsia</i>spp. infections: a review

Botelho-Nevers, Élisabeth; Socolovschi, Cristina; Raoult, Didier; Parola, Philippe

doi:10.1586/eri.12.139

Cited by 86 publications

(73 citation statements)

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“…This regimen is associated with better outcomes than other regimens (478). It is also evident that doxycycline should be used in children presenting with severe rickettsial disease and should be considered by all physicians in light of its good tolerance.…”

Section: Treatment Perspectivementioning

confidence: 99%

“…However, because we do not recommend the use of fluoroquinolones for the treatment of MSF, prospective studies of other rickettsial diseases seem imprudent. Josamycin and new macrolide compounds, such as clarithromycin and azithromycin, may represent alternatives for the treatment of some rickettsioses, particularly in pregnant women, under strict follow-up and in the absence of severe disease (478). Telithromycin also seems to be highly active in vitro, but in vivo data are lacking; therefore, these drugs should be evaluated further (478).…”

Section: Treatment Perspectivementioning

confidence: 99%

“…Josamycin and new macrolide compounds, such as clarithromycin and azithromycin, may represent alternatives for the treatment of some rickettsioses, particularly in pregnant women, under strict follow-up and in the absence of severe disease (478). Telithromycin also seems to be highly active in vitro, but in vivo data are lacking; therefore, these drugs should be evaluated further (478). In any case, early empirical antibiotic therapy should be prescribed for any suspected ticktransmitted rickettsiosis before confirmation of the diagnosis.…”

Section: Treatment Perspectivementioning

confidence: 99%

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Update on Tick-Borne Rickettsioses around the World: a Geographic Approach

et al. 2013

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SUMMARY Tick-borne rickettsioses are caused by obligate intracellular bacteria belonging to the spotted fever group of the genus Rickettsia . These zoonoses are among the oldest known vector-borne diseases. However, in the past 25 years, the scope and importance of the recognized tick-associated rickettsial pathogens have increased dramatically, making this complex of diseases an ideal paradigm for the understanding of emerging and reemerging infections. Several species of tick-borne rickettsiae that were considered nonpathogenic for decades are now associated with human infections, and novel Rickettsia species of undetermined pathogenicity continue to be detected in or isolated from ticks around the world. This remarkable expansion of information has been driven largely by the use of molecular techniques that have facilitated the identification of novel and previously recognized rickettsiae in ticks. New approaches, such as swabbing of eschars to obtain material to be tested by PCR, have emerged in recent years and have played a role in describing emerging tick-borne rickettsioses. Here, we present the current knowledge on tick-borne rickettsiae and rickettsioses using a geographic approach toward the epidemiology of these diseases.

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Section: Treatment Perspectivementioning

confidence: 99%

Section: Treatment Perspectivementioning

confidence: 99%

Section: Treatment Perspectivementioning

confidence: 99%

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Update on Tick-Borne Rickettsioses around the World: a Geographic Approach

et al. 2013

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“…La razón es que probablemente se requiere individualizar el diagnóstico de la especie de Rickettsia para realizar una recomendación. La excelente revisión citada en la carta 6 incluye varias opciones de segunda línea para el tratamiento de diferentes enfermedades producidas por Rickettsia que incluyen aminoglucósidos (josamicina), quinolonas, macrólidos (especialmente en niños) y cloranfenicol. El uso de fluoroquinolonas y claritromicina para el tratamiento de las fiebres manchadas es controvertido 7 .…”

Section: Sr Editorunclassified

Respuesta a la carta de Faccini et al.

Cortés

Cuervo

2017

Infect

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Reply to Faccini et al. Sr. Editor:Agradecemos los aportes en relación con nuestra publicación 1 . El objetivo del artículo «Enfoque clínico del síndrome febril agudo en Colombia» 1 fue el de conside-rar los posibles diagnósticos etiológicos que se enmarquen dentro de la definición de la duración de la fiebre en el tiempo, definiendo como aguda aquella que tiene una duración de hasta 7 días. Sin embargo, el cuadro de Chagas agudo incluye en su definición de caso probable «Fiebre continua o prolongada mayor de 7 días, acompanado˜ o no de alguno de los siguientes síntomas. . .» 2 . Este criterio ha sido utilizado en los estudios de brotes referenciados en Colombia 3,4 . Por esta razón, no fue incluido como parte de la revisión. Sin embargo, como se anota, dada la creciente frecuencia de la presentación aguda del Chagas en adultos, sería importante incluirlo en el diagnóstico diferencial de pacientes con síndrome febril agudo no especificado prolongado (más de 7 días). Un resumen presentado en el XXV Congreso Colombiano de Cardiología y Cirugía Cardiovascular, realizado en marzo de 2014 en Medellín, recopiló información de 56 pacientes en 8 brotes en Colombia entre los años 2008 y 2010, mostrando la creciente frecuencia de este tipo de eventos 5 . Estos hallazgos sugieren que los brotes de Chagas oral pueden ser una forma relativamente frecuente de presentación que se encuentra subestimada en nuestro medio, y cuyo diagnóstico debe considerarse en el paciente que persiste con fiebre más allá de 7 días, escapando el enfoque presentado en el artículo.Por otro lado, aunque existe consenso en el uso de doxiciclina como tratamiento de primera línea en pacientes con rickettsiosis, no lo hay en relación a una posible segunda lí-nea. La razón es que probablemente se requiere individualizar el diagnóstico de la especie de Rickettsia para realizar una recomendación. La excelente revisión citada en la carta 6 incluye varias opciones de segunda línea para el tratamiento de diferentes enfermedades producidas por Rickettsia que incluyen aminoglucósidos (josamicina), quinolonas, macrólidos (especialmente en niños) y cloranfenicol. El uso de fluoroquinolonas y claritromicina para el tratamiento de las fiebres manchadas es controvertido 7 . Además, Parola et al. 8ofrecen una aproximación de tratamientos según diferentes condiciones como el embarazo y los niños, y adicionalmente presenta las propuestas terapéuticas según los causantes de las fiebres manchadas.Como se anota, en casos de R. conorii y Orientia tsutsugamushi hay reportes de fallos, sin embargo su frecuencia en el país no ha sido reportada 9 . Para el caso de R. typhi, sí reportada en el país 10 , se han reportado potenciales susceptibilidades in vitro a las quinolonas pefloxacina, ofloxacina y ciprofloxacina 11 . Estamos de acuerdo en que dada la relativa alta frecuencia como etiología del síndrome febril agudo en el país, debe investigarse más al respecto de la epidemiología y alternativas de tratamiento.

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“…Classic antibiotic therapy consists of tetracyclines or chloramphenicol, although the use of chloramphenicol in developed countries is limited by its bone marrow toxicity (5).…”

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confidence: 99%

Randomized Trial of Clarithromycin for Mediterranean Spotted Fever

Antón

Muñoz

Travería

et al. 2016

Antimicrob Agents Chemother

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The classic antibiotic treatment for Mediterranean spotted fever (MSF) is based on tetracyclines or chloramphenicol, but chloramphenicol's bone marrow toxicity makes tetracyclines the treatment of choice. However, it is convenient to have alternatives available for patients who are allergic to tetracyclines, pregnant women, and children <8 years old. We conducted a randomized clinical trial to compare clarithromycin with doxycycline or josamycin in the treatment of MSF. Forty patients were evaluated (23 male; mean age, 39.87 years); 13 patients were aged <14 years. Seventeen patients received clarithromycin, and 23 received doxycycline or josamycin. The interval between the onset of symptoms and the start of treatment was 4.04 ؎ 1.70 days in the clarithromycin group versus 4.11 ؎ 1.60 days in the doxycycline/josamycin group (P ‫؍‬ not significant [NS]). Time to the disappearance of fever after treatment was 2.67 ؎ 1.55 days in the clarithromycin group versus 2.22 ؎ 1.35 days in the doxycycline/ josamycin (P ‫؍‬ NS). The symptoms had disappeared at 4.70 ؎ 2.25 days in the clarithromycin group versus at 4.75 ؎ 3.08 days in the doxycycline/josamycin (P ‫؍‬ NS). There were no adverse reactions to treatment or relapses in either group. In conclusion, clarithromycin is a good alternative to doxycycline or josamycin in the treatment of MSF. Mediterranean spotted fever (MSF) is a spotted fever group rickettsiosis. Caused by Rickettsia conorii, MSF is endemic in the Mediterranean area. Clinically, MSF is characterized by fever, exanthema, and the inoculation eschar known as tache noire. MSF affects people of both sexes and all ages (1-3).Antibiotic therapy helps prevent progression to severe disease and the associated mortality (4). Classic antibiotic therapy consists of tetracyclines or chloramphenicol, although the use of chloramphenicol in developed countries is limited by its bone marrow toxicity (5).Both in vitro and in vivo studies have shown that doxycycline is highly efficacious in this group of rickettsiosis. Even short-course treatments with doxycycline are highly effective (6). Nevertheless, it would be useful to have alternative treatments for patients allergic to tetracyclines, pregnant women, and children Ͻ8 years old.In vitro studies have shown that rifampin, the fluoroquinolones, and some macrolides have good activity against R. conorii (7, 8); however, of these, only josamycin has proven efficacy in vivo (9). Although josamycin has been commercially available for years in some countries (e.g., France, Switzerland, Austria, Italy, South Africa, and Spain), it is unavailable in many others. Thus, it would be useful to have another antibiotic that can be obtained in most countries to treat MSF.Several studies showed that clarithromycin and its metabolite 14-hydroxyclarithromycin have excellent in vitro activity against R. conorii and Rickettsia rickettsii (10-12), and these results were confirmed in clinical studies, where clarithromycin was efficacious and safe in treating children with spotted fever group...

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Treatment ofRickettsiaspp. infections: a review

Cited by 86 publications

References 88 publications

Update on Tick-Borne Rickettsioses around the World: a Geographic Approach

Update on Tick-Borne Rickettsioses around the World: a Geographic Approach

Respuesta a la carta de Faccini et al.

Randomized Trial of Clarithromycin for Mediterranean Spotted Fever

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