Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

INITIAL

suspected Rocky Mountain spotted fever

1st line – doxycycline

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INITIAL
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suspected Rocky Mountain spotted fever
1st line – 

doxycycline

Doxycycline is the treatment of choice in patients of all ages.[1][19]​ Doxycycline should be given intravenously to critically ill, vomiting, or obtunded patients and orally to all other patients. Because doxycycline can cause significant pain when administered into peripheral veins, it is advisable to switch to oral administration once this can be tolerated.

Therapy should begin as soon as diagnosis is suspected, without waiting for confirmatory testing, and is generally continued until the patient has been afebrile for at least 2 to 3 days. This usually results in a total course of 5 to 7 days of therapy; in severe or complicated cases, the course may be prolonged to 10 to 14 days.

Although repeated courses of tetracycline were associated with staining of permanent teeth in young children, no evidence suggests that doxycycline causes any such tooth staining.[23][24][25] Centers for Disease Control and Prevention: research on doxycycline and tooth staining Opens in new window

The care of pregnant women or patients with a doxycycline allergy should be undertaken in consultation with an infectious diseases specialist.[19]​ Pregnant women should be counseled on the potential risks and benefits when making a treatment decision.[26]​

Primary options

doxycycline: children <45 kg body weight: 2.2 mg/kg orally/intravenously twice daily; children ≥45 kg body weight and adults: 100 mg orally/intravenously twice daily

Plus – empiric antibiotic therapy

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INITIAL
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suspected Rocky Mountain spotted fever
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meningococcal or other pyogenic infectious disease or staphylococcal sepsis or toxic shock syndrome cannot be excluded
Plus – 

empiric antibiotic therapy

Treatment recommended for ALL patients in selected patient group

For those whose presentation may be consistent with a serious different bacterial infection, therapy needs to begin presumptively, and empiric antibiotics are indicated until blood cultures or clinical course rule out the alternative diagnosis.

An antibiotic active against  Neisseria meningitidis, such as a parenteral third-generation cephalosporin, is also appropriate for other bacterial infections that can rarely mimic Rocky Mountain spotted fever (e.g., pneumococcal bacteremia in asplenic hosts). If sepsis or toxic shock syndrome caused by Staphylococcus aureus cannot be excluded, empiric therapy is appropriate. Treatment is continued until cultures and clinical course exclude other infections. 

See Meningococcal disease, Sepsis, or Toxic shock syndrome.

Plus – aggressive supportive therapy

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INITIAL
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suspected Rocky Mountain spotted fever
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critically ill
Plus – 

aggressive supportive therapy

Treatment recommended for ALL patients in selected patient group

Consultation with critical care specialists should be considered, if available.

Intravenous fluid and electrolyte therapy, blood product transfusion, and specific therapies for seizures, intracranial hypertension, shock, acute respiratory distress syndrome, renal failure, or other complications may be required.[1][13]​​

Hyponatremia is often present but rarely requires specific management; serum sodium concentration normalizes as disease resolves.

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Choose a patient group to see our recommendations

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

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