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How is tularemia treated?
Last reviewed: 06.07.2025
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Patients with suspected tularemia are hospitalized based on clinical indications. Windows in the wards should be covered with mesh to prevent the infection from spreading by transmission.
In the acute period, patients need bed rest and a complete diet enriched with vitamins. Care is of great importance. Medical personnel must monitor compliance with sanitary and hygienic rules and conduct ongoing disinfection using a 5% phenol solution, a solution of mercury chloride (1:1000) and other disinfectants.
Etiotropic treatment of tularemia is carried out using aminoglycosides and tetracyclines (standard of treatment).
Streptomycin is prescribed at 0.5 g twice a day intramuscularly, and in the 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 - at 10-15 mg/kg per day in 2-3 doses.
Treatment of moderate tularemia of the bubonic and ulcerative-bubonic forms consists of oral administration of doxycycline at a daily dose of 0.2 g or tetracycline at 0.5 g four times a day. Tetracyclines are not prescribed to pregnant women, children under eight years of age, people with impaired renal or hepatic function, or severe lymphopenia.
The second line of antibiotics includes third-generation cephalosporins, rifampicin, chloramphenicol, fluoroquinolones, used in age-appropriate doses. Currently, ciprofloxacin is considered as an alternative to aminoglycosides in the treatment of tularemia.
Antibacterial treatment of tularemia is 10-14 days (up to the 5th-7th day of normal temperature). In case of relapse, an antibiotic is prescribed that was not used during the first wave of the disease, simultaneously extending the course of antibacterial therapy.
In the presence of skin ulcers and buboes (before suppuration occurs), local compresses, ointment dressings, thermal procedures, warming with Sollux, blue light, quartz, laser irradiation, and diathermy are recommended.
If the bubo becomes purulent and fluctuation occurs, surgical intervention is necessary: opening the lymph node with a wide incision, emptying it of pus and necrotic masses and drainage. It is not recommended to open the vesicle or pustule at the site of the insect bite.
Pathogenetic treatment of tularemia includes detoxification, antihistamines and anti-inflammatory drugs (salicylates), vitamins and cardiovascular agents, and is carried out according to indications. In case of eye damage (oculobubonic form), they should be washed 2-3 times a day and instilled with a 20-30% solution of sodium sulfacyl; in case of angina, rinsing with nitrofural, a weak solution of potassium permanganate is prescribed.
The patient can be discharged from the hospital within a week with normal temperature, satisfactory condition, scarring of skin ulcers, reduction of mobile and painless lymph nodes to the size of a bean or plum stone. Sclerosis of the bubo is not considered a contraindication to discharge. Patients who have had the abdominal form are discharged with a stable normal temperature for a week or more, normal gastrointestinal function. Discharge of patients who have had the oculoglandular form is carried out after consultation with an ophthalmologist. When discharging a patient after the pulmonary form of tularemia, it is necessary to conduct a control fluoroscopy or chest X-ray.
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