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

adults

1st line – tetracyclines

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INITIAL
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adults
1st line – 

tetracyclines

Doxycycline is recommended first line.[21][68] Response to doxycycline is excellent in most cases, and relapse after successful therapy has never been reported.[69][77]​​[122]​​

Although doxycycline is not usually used in pregnancy, it can be used in cases that are considered serious or life threatening.

Tetracycline is less well tolerated than doxycycline and requires more frequent dosing. It is not recommended in pregnant women due to adverse effects on fetal osseous and dental development.[69][132]

Patients should receive medication orally unless severely ill or otherwise unable to tolerate oral medication, in which case medication is given intravenously.

Treatment course is at least 3 days after fever ends, usually 5 to 10 days.

Primary options

doxycycline: 100 mg orally/intravenously every 12 hours

Secondary options

tetracycline: 500 mg orally four times daily

2nd line – rifampin

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INITIAL
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adults
2nd line – 

rifampin

Rifampin is a good second-line agent in patients who are allergic, or have contraindications, to tetracyclines.[68][123]​​[128]​​[129]​​[131]​​

Rifampin has been used in pregnant women with some success.

Patients should receive medication orally unless severely ill or otherwise unable to tolerate oral medication, in which case medication is given intravenously.

Treatment course is at least 3 days after fever ends, usually 5 to 10 days.

Primary options

rifampin: 300 mg orally/intravenously every 12 hours

children

1st line – doxycycline

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INITIAL
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children
1st line – 

doxycycline

Doxycycline is recommended first line in all children, regardless of age, as the risk of dental and osseous adverse effects is considered negligible with the short course of treatment used for this indication.[21][68]​​[69]​​[133]​​

Response to doxycycline is excellent in most cases, and relapse after successful therapy has never been reported.[69][77][122]​​

Patients should receive medication orally unless severely ill or otherwise unable to tolerate oral medication, in which case medication is given intravenously.

Treatment course is at least 3 days after fever ends, usually 5 to 10 days.

Primary options

doxycycline: children <45 kg: 2.2 mg/kg orally/intravenously every 12 hours; children >45 kg: 100 mg orally/intravenously every 12 hours

2nd line – rifampin

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INITIAL
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children
2nd line – 

rifampin

Rifampin may be used second line in children who are allergic, or have contraindications, to doxycycline.[68]

Patients should receive medication orally unless severely ill or otherwise unable to tolerate oral medication, in which case medication is given intravenously.

Treatment course is at least 3 days after fever ends, usually 5 to 10 days.

Primary options

rifampin: 10 mg/kg orally/intravenously every 12 hours, maximum 600 mg/day

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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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