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 with a chief complaint of fever. 8 days PTC- patient experience undocumented fever, associated with generalized body malaise, nausea, loss of apetite, and headache. Patient self medicated with Bioflu which afforded temporary relief. No consult and labs done. 6 days PTCpersistence of above symptoms, with more pronounced left leg pain, and bilateral eye redness, still no consult done. 5 days PTA- patient condition improved was eating well, afebrile, more energetic. 3 days PTCundocumented fever recurred, associated with tea colored urine, nausea, loss of apetite and 2 episode of vomiting. Few hours PTC- above symptoms persisted prompted consult hence admission. Past Medical History Non-asthmatic, with no known allergies, nondiabetic, non hypertensive, with no known heart disease. Hospitalized 10 years ago due to DHF. Personal and Social History A 3rd year nursing student, who wave in floodwater 3 weeks ago after a heavy downpour. Non smoker, non alcoholic beverage drinker. ROS Unremarkable Physical Examination BP 130/90 HR 96 RR 22 38.9 (+) subconjunctival suffusion (+) dry tongue and oral mucosa (+) tenderness of left thigh Laboratory Workups CBC – WBC 13, 800 Hg 12.8 Hct 34 Neutrophils Seg 80 LyMphocytes 32 Monocytes 2 Eosinophils 2 Urine • • • • • • • • • • yellow, clear, (-) sugar, Specific gravity 1.020, WBC 2-3, RBC too numerous to count, No Cast, Na 137, K 3.8, BUN 28, Creatinine 2.20 Lepto MAT: there is a rise in the titer. DIAGNOSIS: Leptospirosis Table 164-1 Treatment and Chemoprophylaxis of Leptospirosis
Purpose of Administration Treatment Mild leptospirosis Doxycycline, 100 mg orally bid or Ampicillin, 500–750 mg orally qid or Amoxicillin, 500 mg orally qid Penicillin G, 1.5 million units IV qid or Ampicillin, 1 g IV qid or Amoxicillin, 1 g IV qid or Ceftriaxone, 1 g IV once daily or Cefotaxime, 1 g IV qid or Erythromycin, 500 mg IV qid Doxycycline, once a week 200 mg orally Drug Regimen

Moderate/severe leptospirosis

Chemoprophylaxis

Jawetz: Treatment of mild leptospirosis should be with oral
doxycycline, ampicillin, or amoxicillin. Treatment of moderate or severe disease should be with intravenous penicillin or ampicillin.

MY ASSESSMENT: Mild Leptospirosis Harrisons: acute influenza-like illness, with fever, chills,
severe headache, nausea, vomiting, and myalgias. Muscle pain, which especially affects the calves, back, and abdomen, is an important feature of leptospiral infection; most common finding on physical examination is fever with conjunctival suffusion; less common findings include muscle tenderness

REPORTER’S OPINION: Moderate to Severe Leptospirosis Harrisons: Weil's syndrome, the most severe form of
leptospirosis, is characterized by jaundice, renal dysfunction, and hemorrhagic diathesis; by pulmonary involvement in many cases

DRUG OF CHOICE Mild Leptospirosis: Doxycycline Moderate to Severe Leptospirosis: Penicillin G ALTERNATIVES Mild: I would recommend Amoxicillin because this is better absorbed by the GI tract Moderate to Severe: Based on the reporter’s sane criteris, I would recommend Ampicillin

toxicity. nausea. GI irritation. MD Department of Internal Medicine Ospital ng Maynila Medical Center Quirino Avenue. Malubay Judee Marie A. Oral amoxicillin is an alternative therapy for children <9 years of age. Malubay Lic # 0870098 . diarrhea and tooth discoloration Judee Marie A. Refill: none Warning: Do not give to children less than 8 years old and to pregnant women. Do not take with dairy products.MED THERA – Leptospirosis Page 2 of 6 PRESCRIPTIONS Mild Computations Judee Marie A. Take with one full glass of water and remain upright for 30 minutes. Malubay. Manila Name: ___________ ___________________________ Date: Age/Sex: Stock Dose: 100 mg capsule Adult: 200 mg BID Pediatric (> 8 years and <45 kg): 4 mg/kg/day BID Assuming 50 kg: 50 kg x 4 mg/kg = 200 mg/day (100 mg BID) Nelson’s Pediatrics: treatment with penicillin or tetracycline (in children 9 yr of age or older) should be instituted as soon as the diagnosis is suspected. with tetracycline (10–20 mg/kg/day divided every 6 hr PO or IV for 7 days) as an alternative for patients allergic to penicillin. Address: __________________________ ______________ Doxycycline (Doxicon) 100 mg/capsule #14 capsules Sig: Take one capsule with food every 12 hours for 7 days. Parenteral penicillin G (6–8 million U/m2/day divided every 4 hr IV for 7 days) is recommended. vomiting.

MD Department of Internal Medicine Ospital ng Maynila Medical Center Quirino Avenue. 6 0 m L Address: __________________________ ______________ Amoxicillin (Amoxil) 500 mg/capsule #28 capsules Sig: Take one capsule every 6 hours with meals for better absorption and to reduce GI discomfort. vomiting. pruritus. Malubay. Refill: none Warning: Nausea. 500 mg F o r t e S y r u p : 2 5 0 m g / 5 m L ( 3 0 m L . 60 mL bottle) Pediatric drops: 125 mg/5 mL (10 mL bottle) . rash.MED THERA – Leptospirosis Page 3 of 6 Computations Judee Marie A. Malubay Judee Marie A. diarrhea. Manila Name: ___________ ___________________________ Date: Age/Sex: Stock Dose: Capsule: 250 mg. Malubay Lic # 0870098 b o t t l e ) Syrup: 125 mg/ 5 mL (30 mL. urticaria Judee Marie A.

MED THERA – Leptospirosis Page 4 of 6 Adult: 250-500 mg every 8 hours (for leptospirosis every 6 hours) Pediatric: Child: ≤10 yr: 125-250 mg every 8 hr. Assuming 30 kg 30 kg x 20 mg/kg = 600 mg/day (every 6 hours for leptospirosis) 150 mg x 5 mL/250 mg = 3 mL every 6 hours 30 kg x 40 mg/kg = 1200 mg/day (every 6 hours for leptospirosis 300 mg x 5 mL/250 mg = 6 mL every 6 hours . <40 kg: 20-40 mg/kg daily in divided doses every 8 hr. Max dose: Infant <3 mth: 30 mg/kg daily in divided doses every 12 hr.

Premature infant and neonate up to 7 Name: ___________________________ Age/Sex: days old: 50 mg/kg daily in 2 divided ___________ doses.6 g = 1 MU Quirino Avenue. Benzylpenicllin (Pencarv) 1 MU/vial #42 vials Sig: After negative pencillin skin test.6-4. Malubay.8 g/day in 2-4 divided doses via IM.2 g should be given at a rate of not >300 mg/minute. Manila Pediatrics: 1 mth-12 yr: 100 mg/kg daily in 4 divided doses. slow IV inj or infusion. Oral amoxicillin is an alternative therapy for children <9 years of age.6 g = 1. Parenteral penicillin G (6–8 million U/m2/day divided every 4 hr IV for 7 days) is recommended. Infant 1-4 wk: 75 mg/kg daily in 3 divided doses.75 g x 1 vial/0. higher Judee Marie A. Assume: 12 y/o weighing 30 kg Address: __________________________ Date: 30 kg x 100 mg/kg = 3000 mg per day ______________ (750 mg qid) 0.MED THERA – Leptospirosis Page 5 of 6 Moderate to Severe Stock Dose: 1 MU/vial. Malubay Lic # 0870098 Judee Marie A. Refill: none Warning: Allergic reactions Judee Marie A. administer 1.5 MU (1. Ospital ng Maynila Medical Center Note: 0. Malubay Computations . MD doses may be needed in more serious Department of Internal Medicine infections. with tetracycline (10–20 mg/kg/day divided every 6 hr PO or IV for 7 days) as an alternative for patients allergic to penicillin. 5 MU/vial Adult: 0.25 vial Nelson’s Pediatrics: treatment with penicillin or tetracycline (in children 9 yr of age or older) should be instituted as soon as the diagnosis is suspected. IV doses >1.5 vial) intravenously every 6 hours for 7 days.

Judee Marie A. Erika Tuazon’s report and excerpts from Jawetz. MD Department of Internal Medicine Ospital ng Maynila Medical Center Quirino Avenue. Harrison’s. <7 days 50 mg/kg/day in divided doses 12 hrly. Nelsons and MIMS. administer 2 vials (1 g) intravenously every 6 hours for 7 days. <20 kg 100-200 mg/kg/day in divided doses 6 hrly. Refill: none Warning: Hypersensitivity superinfection reactions. Katzung (for the dosage of penicillin). Infant: >7 days 75 mg/kg/day in divided doses 8 hrly. anaphylaxis. Malubay This is adapted from Dr. Malubay. Manila Name: ___________ ___________________________ Date: Age/Sex: Computations Stock Dose: Capsule: 500 mg Vial: 250 mg. Assuming 10 kg child 10 kg x 100 mg/kg = 1000 kg/day (250 mg qid) 10 kg x 200 mg/kg = 2000 kg/day (500 mg qid) Address: __________________________ ______________ Ampicillin (Ampicin) 500 mg/vial #28 vials Sig: After negative skin test.com Happy studying!  . 500 mg Adult & Children >20 kg: 250-500 mg 6 hrly.MED THERA – Leptospirosis Page 6 of 6 Judee Marie A. Malubay Lic # 0870098 Judee Marie A.

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