Medical Care

Leptospirosis is treated primarily with antimicrobial therapy. In uncomplicated infections that do not require hospitalization, oral doxycycline has been shown to decrease duration of fever and most symptoms. Hospitalized patients should be treated with intravenous penicillin G therapy, the treatment of choice. A recent clinical trial showed that third-generation cephalosporins are as effective as doxycycline and penicillin in the treatment of acute disease. A review of 7 randomized clinical trials comparing penicillin to no treatment or placebo, as well as penicillin to other agents, yielded inconclusive support for or against antibiotic therapy, especially in severe leptospirosis. A suggestion of shortened duration of illness with IV penicillin did not achieve statistical significance, nor was a difference demonstrated by any intervention in mortality or fever duration.[13] Severe cases of leptospirosis can affect any organ system and can lead to multiorgan failure. In addition to antimicrobials, therapy is supportive. Patients should be managed in a monitored setting because their condition can rapidly progress to cardiovascular collapse and shock. Renal function should be evaluated carefully and dialysis considered in cases of renal failure. In most cases, the renal damage is reversible if the patient survives the acute illness. Access to mechanical ventilation and airway protection should be available in the event of respiratory compromise. Continuous cardiac monitoring should be attained; arrhythmias, including ventricular tachycardia and premature ventricular contractions, as well as atrial fibrillation, flutter, and tachycardia, can occur. A few cases in the literature have reported that plasma exchange, corticosteroids, and intravenous immunoglobulin may be beneficial in selected patients in whom conventional therapy does not elicit a response
Treatment

Medications to treat leptospirosis include:

Ampicillin Ceftriaxone Doxycycline Penicillin

Complicated or serious cases may need supportive care or treatment in a hospital intensive care unit (ICU).
Treatment

Penecilins and other B- lactam antibiotics(PCN at 2M units q6H IM/IV) Teracycline(Doxycycline at 100mg q12H PO) Erythromycin (500mg q12H PO)- if allegic to Penicillin
Nursing Management

Health teaching

Provide education to clients telling them to avoid swimming or wading in potentially contaminated water or flood water. Use of proper protection like boots and gloves when work requires exposure to contaminated water. Drain potentially contaminated water when possible. Control rats in the household by using rat traps or rat poison, maintaining cleanliness in the house.

Management

Isolate the patient and concurrent disinfection of soiled articles. Stringent community-wide rat eradication program.Remove rubbish from work and domestic environment to reduce rodent population. Report all cases of leptospirosis. Investigation of contacts and source of infection Chemoprophylaxis can be done in a group of high risk infected hosts.

Choice of antibiotic
Severe infections should be managed with IV benzyl penicillin and will require hospital admission. Adult dose is 5MU to 8MU per day for five days although in some studies the doses have been routinely very much higher - up to 20MU. There is no evidence that doses over 8MU have an additional benefit, but doses below 5MU may be inadequate. In patients with penicillin allergy, a program of erythromycin can be used at 250mg QID for five days. In mild to moderate cases oral medication using amoxycillin, erythromycin, doxycycline or ampicillin can be used, subject to contraindications and age limits. Typical dosage for doxycycline is 100mg BID PO for ten days. 3G cephalosporins (cefotaxime, etc.) are known to be somewhat effective but the primary drug of choice is always penicillin. A JarischHerxheimer reaction can occasionally be triggered by penicillin therapy, however the risk balance is acceptable and should not provoke discontinuance. Leptospires are usually resistant to vancomycin, chloramphenicol, rifampicin and metronidazole. Multiple antibiotic therapy is not required - there are no clinical examples of in-vitro resistance developing and since human-to-human transmission is extremely rare, the potential for mutative selection of resistance is insignificant.
NSG. DIAGNOSIS -http://www.scribd.com/doc/45095793/NCP-Leptospirosis-new -http://www.scribd.com/full/9492782?access_key=key-znar1yvo6kanxkq5kgj -http://ebookbrowse.com/nursing-care-plan-leptospirosis-pdf-d109419665 -http://www.scribd.com/doc/66882625/Final-Ncp-Leptospirosis -http://www.scribd.com/doc/51383980/Nursing-Care-Plan

Nursing Diagnosis

1. Impaired nutritional needs related to anorexia 2. Increased body temperature (hipertemia) related to increased metabolic diseases 3. Disruption of daily activities related to physical weakness

Nursing Intervention 1. Impaired nutritional needs related to anorexia Expected results : o Nutritional needs are met o Patients are able to eat in accordance with a given portion

Intervention :
o o o o o

Review complaints of nausea and vomiting Give food a little but often Assess how to eat that served Give a warm meal Measure the patient's body weight per day

2. Increased body temperature (hipertemia) related to increased metabolic diseases Expected results : o Temperature within normal limits, free from cold o Do not experience complications related

Intervention :
o o o

Give your bathroom a warm compress, avoid alcohol use Instruct patient to drink plenty Collaboration in the provision of antipyretic

3. Disruption of daily activities related to physical weakness Expected results : o Activities of daily needs are met

Patients capable of self-

Intervention :
o o o o o

Assess the patient's complaint Assess the things that can and can not be patient Help the patient to meet their activity Help the patient to selfPut things in place, easily accessible