title: An open, randomized, controlled trial of penicillin, doxycycline, and cefotaxime for patients with severe leptospirosis.
abstract: BACKGROUND
  Leptospirosis is an important cause of fever in the rural tropics. Since 1996, there has been a marked increase in the incidence of leptospirosis in northeastern Thailand. Although leptospirosis generally is susceptible to antibiotics, there is no consensus regarding the optimal treatment for severe leptospirosis.
  
  
  METHODS
  An open-label, randomized comparison of parenteral cefotaxime, penicillin G sodium (hereafter known as "penicillin G"), and doxycycline for the treatment of suspected severe leptospirosis was conducted. The study involved 540 patients admitted to 4 hospitals in northeastern Thailand.
  
  
  RESULTS
  A total of 264 patients (48.9%) had leptospirosis confirmed by serologic testing or culture. The overall mortality rate was 5%. There were no significant differences between the antibiotics with regard to associated mortality, defervescence, or time to resolution of abnormal findings of laboratory tests either among all study participants or among the subgroup of patients with confirmed leptospirosis. A total of 132 patients had rickettsial infection diagnosed, and, for these patients, treatment with doxycycline was superior to treatment with penicillin G.
  
  
  CONCLUSIONS
  Doxycycline or cefotaxime is a satisfactory alternative to penicillin G for the treatment of severe leptospirosis.
authors.affiliation: Department of Medicine, Faculty of Medicine at Siriraj Hospital, Mahidol University, Bangkok, Thailand. siysp@mahidol.ac.th
authors.forename: Yupin
authors.initials: Y
authors.lastname: Suputtamongkol
authors.forename: Kanigar
authors.initials: K
authors.lastname: Niwattayakul
authors.forename: Chuanpit
authors.initials: C
authors.lastname: Suttinont
authors.forename: Kitti
authors.initials: K
authors.lastname: Losuwanaluk
authors.forename: Roongroeng
authors.initials: R
authors.lastname: Limpaiboon
authors.forename: Wirongrong
authors.initials: W
authors.lastname: Chierakul
authors.forename: Vanaporn
authors.initials: V
authors.lastname: Wuthiekanun
authors.forename: Surapee
authors.initials: S
authors.lastname: Triengrim
authors.forename: Mongkol
authors.initials: M
authors.lastname: Chenchittikul
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: White
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002439:Cefotaxime / Q000627:therapeutic use*; D004318:Doxycycline / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007922:Leptospirosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010406:Penicillins / Q000627:therapeutic use*; D012720:Severity of Illness Index
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins; D004318:Doxycycline; D002439:Cefotaxime