Q fever medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]

The mainstay of therapy for Q fever is doxycycline. The chronic form of Q fever is more difficult to treat and can require up to two years of treatment with doxycycline and hydroxychloroquine. Q fever in pregnancy is especially difficult to treat because doxycycline is contraindicated in pregnancy, so preferred treatment is trimethoprim/sulfamethoxazole.

• Q fever^[1]

• 1. Acute Q fever

• 1.1 Adults

• Preferred Regimen: Doxycycline 100 mg PO bid for 14 days

• 1.2 Children

• 1.2.1 Children with age ≥ 8 years

• Preferred regimen: Doxycycline 2.2 mg/kg PO bid for 14 days (maximum 100 mg per dose)

• 1.2.2 Children with age < 8 years with high risk criteria

• Preferred regimen: Doxycycline 2.2 mg/kg PO bid for 14 days (maximum: 100 mg per dose)

• 1.2.3 Children with age < 8 years with mild or uncomplicated illness

• Preferred regimen: Doxycycline 2.2 mg/kg PO bid for 5 days (maximum 100 mg per dose).

• 1.2.3 Children with age < 8 years with mild or uncomplicated illness who remain febrile past 5 days of treatment

• Preferred regimen: Trimethoprim/Sulfamethoxazole 4-20 mg/kg PO bid for 14 days (maximum: 800 mg per dose)

• 1.3 Pregnant women

• Preferred regimen: Trimethoprim/Sulfamethoxazole 160 mg/800 mg PO bid a day throughout pregnancy

• 2. Chronic Q fever

• 2.1 Endocarditis or vascular infection

• Preferred regimen: Doxycycline 100 mg PO bid AND Hydroxychloroquine 200 mg PO tid for ≥18 months
• Note: Consultation recommended for children and pregnant women.

• 2.2 Noncardiac organ disease

• Preferred regimen: Doxycycline 100 mg PO bid AND Hydroxychloroquine 200 mg PO tid
• Note: Consultation recommended for children and pregnant women.

• 2.3 Postpartum with serologic profile for chronic Q fever

• Preferred regimen: Doxycycline 100 mg PO bid AND Hydroxychloroquine 200 mg PO tid for 12 months
• Note (1): Women should only be treated postpartum if serologic titers remain elevated >12 months after delivery (immunoglobulin G phase I titer ≥1:1024). Women treated during pregnancy for acute Q fever should be monitored similarly to other patients who are at high risk for progression to chronic disease (e.g., serologic monitoring at 3, 6, 12, 18, and 24 months after delivery)
• Note (2): There is no current recommendation for Post-Q fever fatigue syndrome

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