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Treatment of leptospirosis
Last reviewed: 23.04.2024
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Treatment of leptospirosis is carried out in a hospital. Hospitalization is conducted according to epidemiological indications. The regime in the acute period is bed rest.
Diet determines the clinical features of the disease. With the dominance of renal syndrome - table number 7, hepatic - table number 5, with combined lesions - table number 5 with salt restriction or table number 7 with restriction of fat.
Indications for hemodialysis
- Two-, three-day anuria.
- Azotemia (urea blood 2.5-3 g / l and above) in combination with:
- acidosis (blood pH less than 7.4);
- alkalosis (blood pH more than 7.4);
- hyperkalemia (above 7-8 mmol / l);
- threat of swelling of the lungs and brain.
Hyperbaric oxygenation is used. In severe hemorrhagic syndrome, prescribe 40-60 mg / day of prednisolone or intravenously 180-240 mg / day.
Prescribe a symptomatic treatment of leptospirosis, a complex of vitamins.
Medicamentous treatment of leptospirosis
Antibacterial treatment of leptospirosis is carried out with penicillin preparations at a dose of 4-6 million units / day or ampicillin at a dose of 4 g / day. With intolerance to penicillin, doxycycline is prescribed 0.1 g twice daily, chloramphenicol at a dose of 50 mg / kg per day. When CNS is affected, the dose of penicillin is increased to 12-18 million units / day, the dose of ampicillin - up to 12 g / day, chloramphenicol - up to 80-100 mg / kg per day.
Antibacterial treatment of leptospirosis should last 5-10 days.
In acute kidney failure, osmotic diuretics (300 ml of 15% mannitol solution, 500 ml of 20% glucose solution), 200 ml of a 4% solution of sodium hydrogen carbonate per day in two doses are injected intravenously in the initial stage with a decrease in the daily amount of urine. 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 case of infectious-toxic shock, intravenously prednisolone is administered intravenously to a patient at a dose of up to 10 mg / kg per day, dopamine according to an individual scheme, then successively intravenously 2-2.5 l of Trisol or quintasol solution, 1-1.5 l of a polarizing mixture (5% glucose solution, 12-15 g of potassium chloride, 10-12 units of insulin). Saline solutions are first injected in a jet, then passing to a drop introduction (with the appearance of pulse and blood pressure). With the development of DIC-syndrome, fresh-frozen plasma, pentoxifylline, sodium heparin, protease inhibitors are used.
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Approximate terms of incapacity for work
Work ability after the disease is restored slowly, but completely. Non-contagious patients can prescribe them 10 days after the temperature normalization with full clinical recovery, in the presence of meningitis - after the sanation of the cerebrospinal fluid.
Approximate terms of restoration of working capacity 1-3 months.
Clinical examination
Clinical examination is carried out for 6 months with a monthly examination of the infectious disease specialist, according to the indications - a nephrologist, an ophthalmologist, a neurologist, a cardiologist. If the pathology persists for 6 months, further monitoring and treatment of leptospirosis is carried out by doctors of the appropriate profile (nephrologist, ophthalmologist, cardiologist) for at least 2 years.