Pre-exposure prophylaxis may be beneficial for people who will be experiencing exposures that

carry a high risk of infection. These include soldiers training in tropicalregions, adventure
tourists who will have freshwater exposure (especially tropical) and veterinarians who will be
working with infected animals. Doxycycline at 200mg once for a single exposure or once a week
throughout ongoing exposure is recommended
(Brown 2008, Guidugli 2000, Heymann 2004).
Antibiotic post-exposure prophylaxis (e.g. doxycycline at 200 mg) is indicated for persons who
have been exposed to leptospires. However, antibiotic prophylaxis is not routinely offered to
protect owners of animals which have been infected with leptospirosis as the risk of transmission
through normal human contact with animals is considered low (e.g. if there is no physical contact
with the animals urine)
(Brown 2008, Heymann 2004).
Doxycycline prophylaxis is contra-indicated in pregnant or breast-feeding women and children
under the age of 8. As indicated, it may be prudent for these individuals to avoid clean-up of
animal wastes and contact with pets during peak periods of transmission (1-3 weeks after onset).
Prompt antibiotic treatment of human cases can reduce the duration of fever, but may not reduce
mortality. Penicillin is the drug of choice, but alternatives are doxycycline, ampicillin,
erythromycin, cephalosporins and quinalone antibiotics (Heymann 2004).

Any suspected case of leptospirosis presenting with acute febrile illness

and various manifestations BUT with stable vital signs, anicteric sclerae,
with good urine output, and no evidence of meningismus / meningeal
irritation, sepsis / septic shock, difficulty of breathing nor jaundice and can
take oral medications is considered MILD LEPTOSPIROSIS and can be
managed on an OUT-PATIENT SETTING. [Grad e A]
Any suspected case of leptospirosis presenting with acute febrile illness

associated with unstable vital signs, jaundice/icteric sclerae, abdominal

pain, nausea, vomiting and diarrhea, oliguria/anuria, meningismus /
meningeal irritation, sepsis / septic shock, altered mental states or difficulty
of breathing and hemoptysis is considered MODERATE SEVERE
LEPTOSPIROSIS and BEST managed in a HEALTHCARE / HOSPITAL
SETTING. [Grade A]
The following laboratory findings are markers of severe leptospirosis and should alert the
practitioner to closely monitor the patient for progression into complications:
1. Complete blood count (CBC) with platelet count leucocytosis (WBC>12,000
2.
3.
4.
5.
6.

cells/cumm) with neutrophilia and thrombocytopenia

Serum creatinine > 3 mg/dL (or CrCl < 20 ml/min) and BUN > 23 mg/dL
Liver function tests - AST/ALT ratio > 4x, Bilirubin > 190 umol/L
Bleeding parameters - prolonged prothrombin time (PT) < 85%
Serum potassium > 4 mmol/L
Arterial blood gas (ABG) - severe metabolic acidosis(ph< 7.2, HCO3 < 10) and
hypoxemia (PaO2 < 60 mmHg, SaO2 < 90%, PF ratio

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