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How is tularemia treated?
Last reviewed: 23.04.2024
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Patients with suspicion of tularemia are hospitalized for clinical reasons. The windows in the rooms should be covered with a grid to prevent the transmission path of infection.
In an acute period, patients need bed rest and full nutrition, enriched with vitamins. Care is of great importance. Medical personnel should monitor compliance with sanitary and hygienic rules and conduct current disinfection using 5% phenol solution, solution of mercury (1: 1000) and other disinfectants.
Etiotropic treatment of tularemia is carried out with the help of aminoglycosides and tetracyclines (standard of treatment).
Streptomycin is prescribed 0.5 g twice a day intramuscularly, and in pulmonary or generalized form - 1 g twice a day. Gentamicin is used parenterally at 3-5 mg / kg per day in 1-2 doses; amikacin - 10-15 mg / kg per day in 2-3 times.
Treatment of tularemia of moderate severity of bubonic and ulcerative-bubonic forms consists in ingestion of doxycycline in a daily dose of 0.2 g or tetracycline to 0.5 g four times a day. Tetracyclines are not prescribed for pregnant women, children under the age of eight. People with impaired renal function, liver, pronounced lymphopenia.
The second series of antibiotics includes third-generation cephalosporins, rifampicin, chloramphenicol, and fluoroquinolones, used in age-related doses. Currently, in the treatment of tularemia ciprofloxacin is considered as a drug alternative to aminoglycosides.
Antibacterial treatment of tularemia is 10-14 days (up to the 5-7th day of normal temperature). In case of relapse, an antibiotic is prescribed, which was not used during the first wave of the disease, while prolonging the course of antibiotic therapy.
In the presence of skin ulcers and buboes (before the suppuration) local compresses, ointment dressings, thermal procedures, warming up with solux, blue light, quartz, laser irradiation, diathermy are recommended.
With suppuration of the bubo, the occurrence of fluctuations, surgical intervention is necessary: opening the lymph node in a wide incision, emptying it of pus and necrotic masses and draining. Do not open the vesicle or pustule at the site of the insect bite.
Pathogenetic treatment of tularemia includes disintoxicacil, antihistamines and anti-inflammatory drugs (salicylates), vitamins and cardiovascular drugs, conducted according to indications. If the eyes are affected (glazopubonna form), they should be washed 2-3 times per day and instilled with 20-30% solution of sodium sulfacil; with angina, rinse with nitrofural, a weak solution of potassium permanganate.
The patient can be discharged from the hospital for a week at normal temperature, satisfactory condition, scarring of skin ulcers, reducing the mobile and painless lymph nodes to the size of the bean or plum bones. Sclerozirovanie bubo is not considered a contraindication to discharge. Patients who have suffered an abdominal form are discharged at a stable normal temperature for a week or more, normal GIT function. The discharge of patients who have recovered from the oculoglandular form is performed after consultation of the ophthalmologist. Writing out a patient after pulmonary tularemia, it is necessary to carry out a check-up fluoroscopy or chest X-ray.
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