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Treatment of leptospirosis
Last reviewed: 04.07.2025
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Treatment of leptospirosis is carried out in a hospital setting. Hospitalization is carried out according to epidemiological indications. Bed rest is recommended during the acute period.
The diet is determined by the clinical features of the disease. If the renal syndrome is dominant - table No. 7, if the liver syndrome is dominant - table No. 5, if there are combined lesions - table No. 5 with salt restriction or table No. 7 with fat restriction.
Indications for hemodialysis
- Two- or three-day anuria.
- Azotemia (blood urea 2.5-3 g/l and higher) in combination with:
- acidosis (blood pH less than 7.4);
- alkalosis (blood pH greater than 7.4);
- hyperkalemia (above 7-8 mmol/l);
- the threat of pulmonary and cerebral edema.
Hyperbaric oxygenation is used. In case of severe hemorrhagic syndrome, 40-60 mg/day of prednisolone is prescribed orally or 180-240 mg/day intravenously.
Symptomatic treatment of leptospirosis and a vitamin complex are also prescribed.
Drug treatment of leptospirosis
Antibacterial treatment of leptospirosis is carried out with penicillin preparations at a dose of 4-6 million U/day or ampicillin at a dose of 4 g/day. In case of penicillin intolerance, doxycycline is prescribed at 0.1 g twice a day, chloramphenicol at a dose of 50 mg/kg per day. In case of CNS damage, the penicillin dose is increased to 12-18 million U/day, the ampicillin dose - up to 12 g/day, chloramphenicol - up to 80-100 mg/kg per day.
Antibacterial treatment for leptospirosis should last 5-10 days.
In acute renal failure at the initial stage, with a decrease in the daily amount of urine, osmotic diuretics are administered intravenously (300 ml of 15% mannitol solution, 500 ml of 20% glucose solution), 200 ml of 4% sodium bicarbonate solution per day in two doses. In the anuric stage, large doses of saluretics (up to 800-1000 mg / day of furosemide), anabolic steroids (methandienone 0.005 g 2-3 times a day), 0.1 g / day of testosterone are administered.
In infectious toxic shock, the patient is given intravenous prednisolone at a dose of up to 10 mg/kg per day, dopamine according to an individual scheme, then sequentially intravenously 2-2.5 liters of a solution such as trisol or quintasol, 1-1.5 liters of a polarizing mixture (5% glucose solution, 12-15 g of potassium chloride, 10-12 U of insulin). Saline solutions are initially administered by jet, then switched to drip administration (when a pulse and arterial pressure appear). In the development of DIC syndrome, fresh frozen plasma, pentoxifylline, sodium heparin, and protease inhibitors are used.
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Approximate periods of incapacity for work
The ability to work after the disease is restored slowly, but completely. The non-contagiousness of patients allows them to be discharged 10 days after the temperature has returned to normal with complete clinical recovery, in the presence of meningitis - after the sanitation of the cerebrospinal fluid.
Approximate time for restoration of working capacity is 1-3 months.
Clinical examination
The medical examination is carried out for 6 months with monthly examination by an infectious disease specialist, and, if indicated, by a nephrologist, ophthalmologist, neurologist, cardiologist. If the pathology persists for 6 months, further observation and treatment of leptospirosis is carried out by doctors of the corresponding profile (nephrologist, ophthalmologist, cardiologist) for at least 2 years.