Rat-bite fever medical therapy

Responds to penicillin antibiotics. In cases allergic to penicillin, erythromycin or tetracyclines can be used for respectively streptobacillary or spirillary infections.

• Streptobacillus moniliformis treatment^[1]

• 1. Migratory arthropathy and arthritis

• Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.

• 2. Diarrhea, (especially kids) liver or spleen abscess

• Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.

• 3. Undifferentiated fever

• Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.

• 4. Endocarditis, myocarditis, pericarditis (cardiac)

• Preferred regimen: Penicillin 20 MU/day IV divided q4h. Optimal duration recommendation for infective endocarditis is 4 weeks.
• Alternative regimen: Cephalosporins–Ceftriaxone OR Clindamycin OR Erythromycin OR Chloramphenicol AND Streptomycin.

• 5. Meningitis, brain abscess

• Preferred regimen: Penicillin 20 MU/day IV divided q4h.
• Alternative regimen: Cephalosporins–Ceftriaxone OR Clindamycin OR Erythromycin OR Chloramphenicol AND Streptomycin.

• 6. Anemia

• Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.

• 7. Pneumonia

• Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.

• 8. Amnionitis (pregnancy)

• Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.

• 9. Renal abscess

• Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.

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