Table 1: Spotted Fever Group Rickettsiosis other than Rocky Mountain Spotted Fever (due to R. rickettsii), and rickettsialpox (due to R. akari) which are presented in specific chapters.
|
Syndrome |
Rickettsia sp. |
Arthropod vector |
Geographic |
|
Mediterranean spotted fever |
R. conorii |
Rhipicephalus sanguineus ticks |
Mediterranean areas |
|
Siberian tick typhus |
R. sibirica |
Dermacentor ticks |
Europe, USSR, China |
|
Israeli spotted fever |
unnamed |
R. sanguineus ticks |
Israel, Portugal, Sicily |
|
Queensland tick typhus |
R. australis |
Ixodes holocytus ticks |
Queensland (Australia) |
|
Japanese or Oriental spotted fever |
R. japonica |
Dermacentor and Haemaphysalis ticks |
Japan |
|
Flinders Island spotted fever |
R. honei |
unknown |
Flinder Islands (Australia) |
|
Astrakhan fever |
unnamed |
R. sanguineus ticks R. pumilio ticks |
Astrakhan region (Russia) |
|
African tick bite fever |
R. africae |
Amblyomma variegatum ticks |
Africa, West Indies |
|
Flea typhus of California |
R. felis |
cat fleas (Ctenocephalides felis) |
United States, Mexico |
|
spotted fever |
Rickettsia mongolotimonae |
Hyalomma ticks |
Europe, People’s Republic of China |
|
Wood scar |
R. slovaca |
Dermacentor marginatus |
Europe |
Table 2: In Vitro antibiotic susceptibility of R. conorii. MICs (mg/L) are presented for R. conorii Moroccan (ATCC VR-141) and Seven
(ATCC VR-613) strains as determined by using the plaque assay and the dye uptake assay, and for R. conorii Seven as determined by
using an indirect fluorescent antibody (IFA) test.
|
Antibiotics |
MICs in cell cultures (mg/L) |
References |
|||
|
|
Plaque assay |
Dye uptake |
IFA test |
Strain |
|
|
amoxicillin |
128 |
128 |
|
Moroccan |
|
|
|
128 |
128 |
|
7 |
|
|
gentamicin |
8 |
8 |
|
Moroccan |
|
|
|
8 |
8 |
|
7 |
|
|
chloramphenicol |
0.5 |
0.25 |
|
Moroccan |
|
|
thiamphenicol |
1 |
2 |
|
Moroccan |
|
|
|
1 |
2 |
|
7 |
|
|
tetracycline |
0.25 |
0.25 |
|
Moroccan |
|
|
doxycycline |
0.06 |
0.12 |
|
Moroccan |
|
|
|
0.06 |
0.125 |
|
7 |
|
|
erythromycin |
4 |
4 |
|
Moroccan |
|
|
|
8 |
8 |
|
7 |
|
|
|
|
|
8 |
7 |
|
|
spiramycin |
16 |
32 |
|
Moroccan |
|
|
josamycin |
1 |
1 |
|
Moroccan |
|
|
|
0.5 |
0.5 |
|
7 |
|
|
pristinamycin |
2 |
2 |
|
Moroccan |
|
|
|
2 |
1 |
|
7 |
|
|
clarithromycin |
2 |
2 |
|
Moroccan |
|
|
|
1 |
1 |
|
7 |
|
|
|
|
|
4 |
7 |
|
|
azithromycin |
|
|
16 |
7 |
|
|
dirithromycin |
|
|
16 |
7 |
|
|
roxithromycin |
|
|
16 |
7 |
|
|
telithromycin |
|
|
0.5 |
Moroccan |
|
|
rifampin |
0.25 |
0.25 |
|
Moroccan |
|
|
|
0.125 |
0.125 |
|
7 |
|
|
ciprofloxacin |
0.25 |
0.25 |
|
Moroccan |
|
|
|
0.5 |
0.5 |
|
7 |
|
|
|
|
|
16.3 |
7 |
|
|
ofloxacin |
1 |
|
|
Moroccan |
|
|
|
1 |
1 |
|
7 |
|
|
|
|
|
5.2 |
7 |
|
|
pefloxacin |
1 |
0.5 |
|
Moroccan |
|
|
|
0.5 |
1 |
|
7 |
|
|
sparfloxacin |
0.25 |
0.5 |
|
Moroccan |
|
|
|
|
|
1.1 |
7 |
|
|
levofloxacin |
|
|
1.6 |
7 |
|
|
sulfamethoxazole |
>8 |
>8 |
|
Moroccan |
|
|
|
>8 |
>8 |
|
7 |
|
Table 3: In Vitro antibiotic susceptibility of Spotted Fever Group Rickettsiae other than R. rickettsii, R; conorii, and R. akari. Minimum Inhibitory Concentrations (mg/L) as determined in the plaque assay are summarized (52).
|
Strain |
Doxy |
Thiam |
Rifam |
Ery |
Clar |
Josa |
Prist |
Cip |
Ofl |
Pef |
|
R. conorii serotype Israeli |
0.06 |
1 |
0.5 |
4 |
1 |
0.5 |
1 |
0.5 |
1 |
1 |
|
R. conorii serotype Astrakhan (A-167) |
0.06 |
0.5 |
0.03 |
8 |
0.5 |
0.5 |
2 |
0.5 |
0.5 |
0.5 |
|
R. sibirica (246) |
0.06 |
0.5 |
0.06 |
2 |
2 |
1 |
2 |
1 |
1 |
1 |
|
R. australis (Phillips) |
0.06 |
2 |
0.125 |
8 |
4 |
0.5 |
2 |
0.5 |
1 |
1 |
|
R. japonica (YM) |
0.125 |
1 |
0.25 |
8 |
1 |
1 |
8 |
1 |
1 |
1 |
|
R. honei (RB) |
0.06 |
2 |
0.5 |
4 |
1 |
0.5 |
2 |
1 |
1 |
1 |
|
R. africae (ESF-5) |
0.125 |
1 |
0.125 |
8 |
2 |
0.5 |
2 |
0.5 |
1 |
1 |
|
R. "mongolotimonae" |
0.125 |
1 |
0.125 |
8 |
4 |
1 |
2 |
1 |
1 |
1 |
|
R. slovaca (13-B) |
0.06 |
1 |
0.5 |
2 |
0.5 |
1 |
1 |
1 |
1 |
1 |
doxy : doxycycline; thiam :
thiamphenicol; rifam : rifampin; ery : erythromycin; clar : clarithromycin; josa
: josamycin; prist : pristinamycin; cip : ciprofloxacin; ofl : ofloxacin; pef :
pefloxacin.
Table 4 : In Vitro antibiotic susceptibility of Rickettsiae isolated only from ticks. Minimum Inhibitory Concentrations (mg/L) as determined in the plaque assay are summarized (52).
|
Strain |
Doxy |
Thiam |
Rifam |
Ery |
Clar |
Josa |
Prist |
Cip |
Ofl |
Pef |
|
R. bellii (369L42-1) |
0.125 |
0.5 |
0.06 |
4 |
4 |
1 |
2 |
0.5 |
0.5 |
1 |
|
R. canada (2678) |
0.06 |
1 |
0.125 |
4 |
1 |
1 |
2 |
0.5 |
0.5 |
1 |
|
R. helvetica (C9P9) |
0.125 |
1 |
0.06 |
2 |
1 |
0.5 |
2 |
0.25 |
0.5 |
1 |
|
R. parkeri (Maculatum) |
0.25 |
4 |
0.25 |
4 |
1 |
0.5 |
2 |
0.25 |
0.25 |
0.5 |
|
Thai tick typhus rickettsia |
0.06 |
2 |
0.125 |
8 |
1 |
1 |
4 |
0.5 |
2 |
1 |
|
strain Bar 29 |
0.06 |
1 |
2 |
4 |
2 |
0.5 |
4 |
0.25 |
0.5 |
0.5 |
|
R. massiliae |
0.06 |
1 |
2 |
2 |
1 |
1 |
1 |
0.25 |
0.5 |
0.5 |
|
R. aeschlimanii |
0.06 |
1 |
2 |
8 |
1 |
0.5 |
2 |
0.5 |
0.5 |
1 |
|
R. montana (ATCC VR-611) |
0.125 |
2 |
2 |
8 |
1 |
2 |
4 |
1 |
1 |
1 |
|
R. rhipicephali |
0.25 |
1 |
2 |
4 |
1 |
1 |
2 |
1 |
1 |
1 |
doxy : doxycycline; thiam : thiamphenicol; rifam : rifampin; ery : erythromycin; clar : clarithromycin; josa : josamycin; prist : pristinamycin; cip : ciprofloxacin; ofl : ofloxacin; pef : pefloxacin
Table 5: Summary of randomized clinical trials of antibiotic therapy for Mediterranean Spotted Fever
|
Drugs and regimens |
n° of patients |
Results |
references |
|
doxycycline, 1 day (200mg two times) vs. tetracycline, 10 days (500mg qid) |
70 |
NS |
|
|
clarithromycin, 7 days (7.5 mg bid) vs. chloramphenicol, 7 days (12.5mg/kg qid) |
46 |
more rapid defervescence with clarithromycin |
|
|
erythromycin, 10 days (12.5mg/kg qid) vs. tetracycline, 10 days (10 mg/kg qid) |
81 |
more rapid disappearance of fever and symptoms with tetracycline |
|
|
azithromycin, 3days (10 mg/kg once daily) vs. doxycycline, 5 days (5mg/kg once daily) |
30 |
NS |
|
|
josamycin, 5 days (25 mg/kg bid) vs. doxycycline, 1 day (2.5 mg/kg bid) |
59 |
NS |
|
|
azithromycin, 3 days (10 mg/kg once daily) vs. clarithromycin, 7 days (7.5 mg/kg bid) |
87 |
NS |
|
|
ciprofloxacin, 2 days (500mg bid) vs. doxycycline, 2 days (100mg bid) |
43 |
more rapid disappearance of fever and symptoms with doxycycline |
|
|
ciprofloxacin, 7 days (750mg bid) vs. doxycycline, 7 days (100mg bid) |
70 |
NS |
|
|
rifampin, 5 days (10mg/kg bid) vs. doxycycline, 1 day (200mg two times) |
32 |
more rapid disappearance of fever with doxycycline |
NS: no statistically significant differences in time to disappearance of fever and symptoms
Table 6. Recommendations for antibiotic treatment of Spotted Fever Group Rickettsiosis other than
Rocky Mountain Spotted Fever (due to R. rickettsii), and rickettsialpox (due to R. akari) which are
presented in specific chapters.
|
Condition |
antibiotic |
dose |
duration |
References |
|
spotted fever group rickettsiosis in adult and in child > 8 years |
1. doxycycline |
100 mg b.i.d. p.o. (i.v. in case of severe disease) |
7-14 days |
(4, 6, 18, 33, 34, 55) |
|
2. doxycycline |
200 mg in single or two doses p.o. |
one day |
(4, 6) |
|
|
3. fluoroquinolone |
ofloxacin 200 mg b.i.d. p.o. |
10-14 days |
(7, 16, 21) |
|
|
|
ciprofloxacin 500 mg b.i.d. p.o. |
10-14 days |
(21, 43, 55) |
|
|
4. chloramphenicol |
500mg every 6 hours |
7-14 days |
|
|
|
spotted fever group rickettsiosis in child of less than 8 years old |
1. doxycycline |
4 mg/Kg/day in two doses p.o. (no more than 200mg) |
one day |
(4, 6) |
|
2. macrolide |
josamycin 50 mg/Kg/day b.i.d. p.o. |
7 days |
(6) |
|
|
|
azithromycin 10 mg/Kg/day p.o. |
3 days |
(33) |
|
|
3. chloramphenicol |
500mg every 6 hours |
7-14 days |
|