Editing Leptospirosis (section)

==Treatment==
Most leptospiral cases resolve spontaneously. Early initiation of antibiotics may prevent the progression to severe disease. Therefore, in resource-limited settings, antibiotics can be started once leptospirosis is suspected after [[history]] taking and examination.<ref name="Haake 2015"/>

For mild leptospirosis, antibiotic recommendations such as doxycycline, [[azithromycin]], [[ampicillin]] and [[amoxicillin]] were based solely on ''in vitro'' testing.<ref name="Lane 2016"/> In 2001, the WHO recommended oral doxycycline (2&nbsp;mg/kg up to 100&nbsp;mg every 12&nbsp;hours) for five to seven days for those with mild leptospirosis. [[Tetracycline]], ampicillin, and amoxicillin can also be used in such cases.<ref name="WHO"/> However, in areas where [[rickettsia]] and leptospirosis are both endemic, azithromycin and doxycycline are the drugs of choice.<ref name="Lane 2016"/>

Based on a 1988 study, [[intravenous]] (IV) [[benzylpenicillin]] (also known as penicillin G) is recommended for the treatment of severe leptospirosis.<ref name="Lane 2016"/> Intravenous benzylpenicillin (30&nbsp;mg/kg up to 1.2&nbsp;g every six hours) is used for five to seven days. Amoxicillin, ampicillin, and erythromycin may also be used for severe cases.<ref name="WHO">{{cite book |title=WHO recommended strategies for the prevention and control of communicable diseases |date=2001 |publisher=World Health Organization – Department of Communicable Disease Control, Prevention and Eradication |page=104 |url=https://apps.who.int/iris/bitstream/handle/10665/67088/WHO_CDS_CPE_SMT_2001.13.pdf;jsessionid=8D354664DCE5C486C49F55D4C3F64378?sequence=1 |archive-url=https://web.archive.org/web/20190505060537/https://apps.who.int/iris/bitstream/handle/10665/67088/WHO_CDS_CPE_SMT_2001.13.pdf;jsessionid=8D354664DCE5C486C49F55D4C3F64378?sequence=1 |archive-date=5 May 2019}}</ref> [[Ceftriaxone]] (1&nbsp;g IV every 24&nbsp;hours for seven days) is also effective for severe leptospirosis.<ref name="Haake 2015"/><ref name="Lane 2016"/><ref>{{cite journal | vauthors = Panaphut T, Domrongkitchaiporn S, Vibhagool A, Thinkamrop B, Susaengrat W | title = Ceftriaxone compared with sodium penicillin g for treatment of severe leptospirosis | journal = Clinical Infectious Diseases | volume = 36 | issue = 12 | pages = 1507–13 | date = June 2003 | pmid = 12802748 | doi = 10.1086/375226 | doi-access = free }}</ref> [[Cefotaxime]] (1&nbsp;g&nbsp;IV every six hours for seven days) and doxycycline (200&nbsp;mg initially followed by 100&nbsp;mg&nbsp;IV every 12&nbsp;hours for seven days) are equally effective as benzylpenicillin (1.5&nbsp;million units&nbsp;IV every six hours for seven days).<ref name="Lane 2016"/><ref>{{cite journal | vauthors = Suputtamongkol Y, Niwattayakul K, Suttinont C, Losuwanaluk K, Limpaiboon R, Chierakul W, Wuthiekanun V, Triengrim S, Chenchittikul M, White NJ | display-authors = 6 | title = An open, randomized, controlled trial of penicillin, doxycycline, and cefotaxime for patients with severe leptospirosis | journal = Clinical Infectious Diseases | volume = 39 | issue = 10 | pages = 1417–24 | date = November 2004 | pmid = 15546074 | doi = 10.1086/425001 | doi-access = free }}</ref> Therefore, there is no evidence on differences in death reduction when benzylpenicillin is compared with ceftriaxone or cefotaxime.<ref name="Lane 2016"/> Another study conducted in 2007 also showed no difference in efficacy between doxycycline (200&nbsp;mg initially followed by 100&nbsp;mg orally every 12&nbsp;hours for seven days) or azithromycin (2&nbsp;g on day one followed by 1&nbsp;g daily for two more days) for suspected leptospirosis. There was no difference in the resolution of fever and azithromycin is better tolerated than doxycycline.<ref>{{cite journal | vauthors = Phimda K, Hoontrakul S, Suttinont C, Chareonwat S, Losuwanaluk K, Chueasuwanchai S, Chierakul W, Suwancharoen D, Silpasakorn S, Saisongkorh W, Peacock SJ, Day NP, Suputtamongkol Y | display-authors = 6 | title = Doxycycline versus azithromycin for treatment of leptospirosis and scrub typhus | journal = Antimicrobial Agents and Chemotherapy | volume = 51 | issue = 9 | pages = 3259–63 | date = September 2007 | pmid = 17638700 | pmc = 2043199 | doi = 10.1128/AAC.00508-07 }}</ref><ref name=Fret2012/><ref name="Jaykaran 2013"/>

Outpatients are given doxycycline or azithromycin. Doxycycline can shorten the duration of leptospirosis by two days, improve symptoms, and prevent the shedding of organisms in their urine. Azithromycin and amoxicillin are given to pregnant women and children.<ref name="Haake 2015"/> Rarely, a [[Jarisch–Herxheimer reaction]] can develop in the first few hours after antibiotic administration.<ref name="Lane 2016"/> However, according to a [[meta-analysis]] done in 2012, the benefit of antibiotics in the treatment of leptospirosis was unclear although the use of antibiotics may reduce the duration of illness by two to four days.<ref name="Lane 2016"/><ref name=Fret2012>{{cite journal | vauthors = Brett-Major DM, Coldren R | title = Antibiotics for leptospirosis | journal = The Cochrane Database of Systematic Reviews | issue = 2 | pages = CD008264 | date = February 2012 | pmid = 22336839 | doi = 10.1002/14651858.CD008264.pub2 }}</ref> Another meta-analysis done in 2013 reached a similar conclusion.<ref name="Lane 2016"/><ref name="Jaykaran 2013">{{cite journal | vauthors = Charan J, Saxena D, Mulla S, Yadav P | title = Antibiotics for the treatment of leptospirosis: systematic review and meta-analysis of controlled trials | journal = International Journal of Preventive Medicine | volume = 4 | issue = 5 | pages = 501–10 | date = May 2013 | pmid = 23930159 | pmc = 3733179 }}</ref>

For those with severe leptospirosis, including potassium wasting with high kidney output dysfunction, intravenous hydration and potassium supplements can prevent dehydration and [[hypokalemia]]. When [[acute kidney failure]] occurs, early initiation of [[haemodialysis]] or [[peritoneal dialysis]] can help to improve survival. For those with respiratory failure, [[tracheal intubation]] with low [[tidal volume]] improves survival rates.<ref name="Haake 2015"/>

[[Corticosteroids]] have been proposed to suppress inflammation in leptospirosis because ''Leptospira'' infection can induce the release of [[Cytokine|chemical signals]] which promote [[inflammation]] of blood vessels in the lungs. However, there is insufficient evidence to determine whether the use of corticosteroids is beneficial.<ref name="Lane 2016"/><ref>{{cite journal | vauthors = Rodrigo C, Lakshitha de Silva N, Goonaratne R, Samarasekara K, Wijesinghe I, Parththipan B, Rajapakse S | title = High dose corticosteroids in severe leptospirosis: a systematic review | journal = Transactions of the Royal Society of Tropical Medicine and Hygiene | volume = 108 | issue = 12 | pages = 743–50 | date = December 2014 | pmid = 25266477 | doi = 10.1093/trstmh/tru148 }}</ref>