SUBJECT: Medical Therapeutics

Topic: Leptospirosis
Dr. (Report)
Date
CASE
J.N. a 20 year old male, single, Filipino, Roman
Catholic, presently residing in Paranaque, admitted at Medical
Center Manila for the first time ith a chief complaint of fe!er. "
days P#C$ patient e%perience undocumented fe!er, associated
ith generali&ed 'ody malaise, nausea, loss of apetite, and
headache. Patient self medicated ith (ioflu hich afforded
temporary relief. No consult and la's done. ) days P#C$
persistence of a'o!e symptoms, ith more pronounced left leg
pain, and 'ilateral eye redness, still no consult done. * days
P#+$ patient condition impro!ed as eating ell, afe'rile, more
energetic. , days P#C$ undocumented fe!er recurred,
associated ith tea colored urine, nausea, loss of apetite and 2
episode of !omiting. Fe hours P#C$ a'o!e symptoms
persisted prompted consult hence admission.
Past Medical History
Non$asthmatic, ith no -non allergies, non$ dia'etic,
non hypertensi!e, ith no -non heart disease. .ospitali&ed
/0 years ago due to 0.F.
Personal and Social History
+ ,
rd
year nursing student, ho a!e in floodater ,
ee-s ago after a hea!y donpour. Non smo-er, non alcoholic
'e!erage drin-er.
ROS
1nremar-a'le
Physical Examination
(P /,0230 .R 3) RR 22 ,".3
456 su'con7uncti!al suffusion
456 dry tongue and oral mucosa
456 tenderness of left thigh
8a'oratory 9or-ups
C(C : 9(C /,, "00
.g /2."
.ct ,;
Neutrophils <eg "0
8yMphocytes ,2
Monocytes 2
=osinophils 2
1rine
yello, clear,
4$6 sugar,
<pecific gra!ity /.020,
9(C 2$,,
R(C too numerous to count,
No Cast,
Na /,>,
? ,.",
(1N 2",
Creatinine 2.20
8epto M+#@ there is a rise in the titer.
DIAGNOSIS@ 8eptospirosis
#a'le /);$/ #reatment and Chemoprophyla%is of
8eptospirosis
Purpose o Dru!
Administration
Re!imen
#reatment
Mild leptospirosis 0o%ycycline, /00 mg orally 'id or
+mpicillin, *00:>*0 mg orally qid
or
+mo%icillin, *00 mg orally qid
Moderate2se!ere
leptospirosis
Penicillin A, /.* million units BC qid
or
+mpicillin, / g BC qid or
+mo%icillin, / g BC qid or
Ceftria%one, / g BC once daily or
Cefota%ime, / g BC qid or
=rythromycin, *00 mg BC qid
Chemoprophyla%is 0o%ycycline, 200 mg orally once a
ee-
Jaet&@ #reatment of mild leptospirosis should 'e ith oral
do%ycycline, ampicillin, or amo%icillin. #reatment of moderate or se!ere
disease should 'e ith intra!enous penicillin or ampicillin.
M" ASSESSMEN#$ Mild 8eptospirosis
.arrisons@ acute influen&a$li-e illness, ith fe!er, chills, se!ere
headache, nausea, !omiting, and myalgias. Muscle pain, hich
especially affects the cal!es, 'ac-, and a'domen, is an important
feature of leptospiral infectionD most common finding on physical
e%amination is fe!er ith con7uncti!al suffusionD less common findings
include muscle tenderness
REPOR#ER%S OPINION@ Moderate to <e!ere 8eptospirosis
.arrisons@ 9eilEs syndrome, the most se!ere form of leptospirosis, is
characteri&ed 'y 7aundice, renal dysfunction, and hemorrhagic
diathesisD 'y pulmonary in!ol!ement in many cases
DR&G O' CHOICE
Mild (eptospirosis$ 0o%ycycline
Moderate to Se)ere (eptospirosis@ Penicillin A
A(#ERNA#I*ES
Mild$ B ould recommend +mo%icillin 'ecause this is 'etter
a'sor'ed 'y the AB tract
Moderate to Se)ere$ (ased on the reporterFs sane criteris, B
ould recommend +mpicillin
M=0 #.=R+ : 8eptospirosis
Page 2 of )
PRESCRIP#IONS
Mild

Computations
Stoc+ Dose$ /00 mg capsule
Adult$ 200 mg (B0
Pediatric ,- . years and /01 +!2@ ; mg2-g2day
(B0
+ssuming *0 -g@
*0 -g % ; mg2-g G 200 mg2day 4/00 mg (B06
NelsonFs Pediatrics@ treatment ith penicillin or
tetracycline 4in children 3 yr of age or older6 should 'e
instituted as soon as the diagnosis is suspected.
Parenteral penicillin A 4):" million 12m
2
2day di!ided
e!ery ; hr BC for > days6 is recommended, ith
tetracycline 4/0:20 mg2-g2day di!ided e!ery ) hr PH
or BC for > days6 as an alternati!e for patients allergic
to penicillin. Hral amo%icillin is an alternati!e therapy
for children I3 years of age.
3udee Marie A4 Malu5ay6 MD
0epartment of Bnternal Medicine
Hspital ng Maynila Medical Center
Juirino +!enue, Manila
Name$ 777777777777777777777777777 A!e8Sex$
77777777777
Address$ 77777777777777777777777777 Date$
77777777777777
Doxycycline
40o%icon6
/00 mg2capsule
K/; capsules
Sig: #a-e one capsule ith food e!ery /2 hours for > days.
#a-e ith one full glass of ater and remain upright for ,0
minutes. 0o not ta-e ith dairy products.
Reill@ none
9arnin!$ 0o not gi!e to children less than " years old and to
pregnant omen. AB irritation, to%icity, nausea, !omiting, diarrhea
and tooth discoloration
Judee Marie A. Malubay
3udee Marie A4 Malu5ay
8ic K 0">003"
M=0 #.=R+ : 8eptospirosis
Page , of )
Computations
Stoc+ Dose$
Capsule@ 2*0 mg, *00 mg
F
o
r
t
e

<
y
r
u
p
@

2
*
0

m
g
2

*
m
8

4
,
0

m
8
,

)
0

m
8

'
o
t
t
l
e
6
<yrup@ /2* mg2 * m8 4,0 m8, )0 m8 'ottle6
Pediatric drops@ /2* mg2* m8 4/0 m8 'ottle6
Adult$ 2*0$*00 mg e!ery " hours 4for leptospirosis e!ery )
hours6
Pediatric$ Child: L/0 yr@ /2*$2*0 mg e!ery " hrD I;0 -g@ 20$
;0 mg2-g daily in di!ided doses e!ery " hr. Ma% dose@ Bnfant I,
mth@ ,0 mg2-g daily in di!ided doses e!ery /2 hr.
+ssuming ,0 -g
,0 -g % 20 mg2-g G )00 mg2day 4e!ery ) hours for
leptospirosis6
/*0 mg % * m822*0 mg G , m8
e!ery ) hours
,0 -g % ;0 mg2-g G /200 mg2day 4e!ery ) hours for
leptospirosis
,00 mg % * m822*0 mg G ) m8 e!ery ) hours

3udee Marie A4 Malu5ay6 MD
0epartment of Bnternal Medicine
Hspital ng Maynila Medical Center
Juirino +!enue, Manila
Name$ 777777777777777777777777777 A!e8Sex$
77777777777
Address$ 77777777777777777777777777 Date$
77777777777777
Amoxicillin
4+mo%il6
*00 mg2capsule
K2" capsules
Sig: #a-e one capsule e!ery ) hours ith meals for 'etter
a'sorption and to reduce AB discomfort.
Reill@ none
9arnin!$ Nausea, !omiting, diarrhea, rash, pruritus, urticaria
Judee Marie A. Malubay
3udee Marie A4 Malu5ay
8ic K 0">003"
M=0 #.=R+ : 8eptospirosis
Page ; of )
M=0 #.=R+ : 8eptospirosis
Page * of )
Moderate to Se)ere
Computations
Stoc+ Dose$ / M12!ial, * M12!ial
Adult@ 0.)$;." g2day in 2$; di!ided doses !ia
BM, slo BC in7 or infusion, higher doses may
'e needed in more serious infections. BC doses
M/.2 g should 'e gi!en at a rate of not M,00
mg2minute.
Note@ 0.) g G / M1
Pediatrics$ / mth$/2 yr@ /00 mg2-g daily in ;
di!ided doses. Bnfant /$; -@ >* mg2-g daily in
, di!ided doses. Premature infant and neonate
up to > days old@ *0 mg2-g daily in 2 di!ided
doses.
+ssume@ /2 y2o eighing ,0 -g
,0 -g % /00 mg2-g G ,000 mg per day 4>*0 mg
qid6
0.>* g % / !ial20.) g G /.2* !ial
NelsonFs Pediatrics@ treatment ith penicillin or
tetracycline 4in children 3 yr of age or older6 should
'e instituted as soon as the diagnosis is suspected.
Parenteral penicillin A 4):" million 12m
2
2day di!ided
e!ery ; hr BC for > days6 is recommended, ith
tetracycline 4/0:20 mg2-g2day di!ided e!ery ) hr PH
or BC for > days6 as an alternati!e for patients allergic
to penicillin. Hral amo%icillin is an alternati!e therapy
for children I3 years of age.
3udee Marie A4 Malu5ay6 MD
0epartment of Bnternal Medicine
Hspital ng Maynila Medical Center
Juirino +!enue, Manila
Name$ 777777777777777777777777777 A!e8Sex$
77777777777
Address$ 77777777777777777777777777 Date$
77777777777777
:en;ylpenicllin
4Pencar!6
/ M12!ial
K;2 !ials
Sig: +fter negati!e pencillin s-in test, administer /.* M1
4/.* !ial6 intra!enously e!ery ) hours for > days.
Reill@ none
9arnin!$ +llergic reactions
Judee Marie A. Malubay
3udee Marie A4 Malu5ay
8ic K 0">003"
M=0 #.=R+ : 8eptospirosis
Page ) of )
This is adapted from Dr. Erika Tuazons report and excerpts
from Jawetz, Katzung (for the dosage of penicillin, !arrisons,
"elsons and #$#%.com !app& stud&ing'
Computations
Stoc+ Dose$
Capsule@ *00 mg
Cial@ 2*0 mg, *00 mg
Adult & Children >20 kg: 2*0$*00 mg ) hrly,
<20 kg /00$200 mg2-g2day in di!ided doses )
hrly.
Inant$ -< days >* mg2-g2day in di!ided doses
" hrly, /< days *0 mg2-g2day in di!ided doses
/2 hrly.
+ssuming /0 -g child
/0 -g % /00 mg2-g G /000 -g2day 42*0 mg qid6
/0 -g % 200 mg2-g G 2000 -g2day 4*00 mg qid6
3udee Marie A4 Malu5ay6 MD
0epartment of Bnternal Medicine
Hspital ng Maynila Medical Center
Juirino +!enue, Manila
Name$ 777777777777777777777777777 A!e8Sex$
77777777777
Address$ 77777777777777777777777777 Date$
77777777777777
Ampicillin
4+mpicin6
*00 mg2!ial
K2" !ials
Sig: +fter negati!e s-in test, administer 2 !ials 4/ g6
intra!enously e!ery ) hours for > days.
Reill@ none
9arnin!$ .ypersensiti!ity reactions, anaphyla%is, superinfection
Judee Marie A. Malubay
3udee Marie A4 Malu5ay
8ic K 0">003"