Antimicrobial therapy of leptospirosis

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Abstract
Leptospirosis is an important but often overlooked zoonotic disease that can cause significant morbidity and mortality. The optimal antimicrobial treatment for this disease has not been established. This review summarizes the most recent literature pertaining to the use of antimicrobial agents in the treatment of leptospirosis. Leptospira are highly susceptible to a wide variety of antimicrobials in vitro. Despite this, it is not clear what the best choice of antimicrobial agents is for human disease. Based on the best available literature, the current choices of treatment for leptospirosis include penicillin, doxycycline, cefotaxime, ceftriaxone and azithromycin. Penicillin has long been considered the treatment of choice. Doxycycline is a reasonable alternative, but concerns exist regarding its use in all patients. Recent trials have demonstrated that cefotaxime and ceftriaxone are also acceptable agents. For a variety of reasons, these may be the preferred agents at this time. Azithromycin appears promising for the treatment of less severe disease. Another option for treating leptospirosis is the fluoroquinolone antimicrobials, although adequate human trials are lacking to fully support their use. Leptospirosis is an important cause of morbidity and mortality worldwide. Despite this, the optimal treatment is not fully defined.