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Earlier antibiotics lead to better outcomes with Rocky Mountain spotted fever
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Recent data suggest earlier treatment with doxycycline may reduce morbidity and mortality in American Indian patients with Rocky Mountain spotted fever.
Although Rocky Mountain spotted fever (RMSF) is a treatable disease, it causes significant morbidity and mortality on several American Indian reservations in Arizona, researchers reported in Clinical Infectious Diseases.
The researchers evaluated 205 cases of RMSF diagnosed between 2002 and 2011 in two Arizona tribal communities, comparing fatal (n = 15) vs. nonfatal cases (n = 190) to determine clinical risk factors for mortality. They defined late treatment as a doxycycline regimen started on or later than day 5 of symptoms. Severe outcome was classified as any hospital admission, including ICU admission, or death. Late symptoms were any symptoms with onset on or after day 4 of illness. The researchers obtained information regarding all diagnoses and causes of death from patient medical records.
In fatal cases, doxycycline treatment was started significantly later (median, day 7) vs. nonfatal cases (median, day 3), despite early presentation for treatment by both groups (median, day 2). Factors associated with delayed treatment and mortality included early symptoms of nausea and diarrhea, history of alcoholism or chronic lung disease, and abnormal laboratory results, such as elevated liver transaminases. Frequently, symptoms such as rash, history of tick bite, thrombocytopenia and hyponatremia initially were not present.
Based on these findings, the researchers recommend a low threshold for initiating doxycycline whenever treating febrile or potentially septic patients in this region.
“Improving early consideration of RMSF in patients with complicated presentations, such as those with a history of alcoholism or signs and symptoms of another illness, and for those without classic signs and symptoms of RMSF, such as rash, will reduce mortality,” they wrote.
Disclosure: The researchers report no relevant financial disclosures.
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