title: Analysis of risk factors for malignant Mediterranean spotted fever indicates that fluoroquinolone treatment has a deleterious effect.
abstract: OBJECTIVE
  To identify risk factors for malignant Mediterranean spotted fever (MSF) caused by Rickettsia conorii conorii.
  
  
  METHODS
  Epidemiological, clinical and biological characteristics as well as risk factors (including treatment regimens) for severe MSF cases were analysed retrospectively. A patient with two or more organ dysfunctions or patient death was defined as a severe case.
  
  
  RESULTS
  During the study period (January 1999 to December 2009), 161 MSF cases were referred to our centre for rickettsioses. Twenty-six cases (16.1%) were considered severe, which is 3-fold higher than in our previous studies. The clinical and laboratory findings were comparable to those reported elsewhere except that the type of antibiotic treatment was associated with disease severity. Doxycycline administration prior to deterioration of disease (in 31 patients) protected patients from development of severe MSF [relative risk (RR) 0.248, 95% confidence interval (CI) 0.08-0.76] and induced earlier defervescence compared with the other treatment regimens (3.02 ± 2.2 days versus 7.1 ± 6.57 days, P = 0.021). In contrast, fluoroquinolone treatment (in 21 patients) was significantly and independently associated with MSF severity (RR 2.53, 95% CI 1.40-4.55) and was associated with a significantly longer hospital stay.
  
  
  CONCLUSIONS
  In this retrospective study fluoroquinolone treatment was associated with increased MSF disease severity. Fluoroquinolones have been previously associated with treatment failure in typhus and scrub typhus cases. Thus, we do not recommend the use of fluoroquinolones to treat rickettsial diseases.
authors.affiliation: URMITE UMR CNRS 6236, IRD 198, Université de la Méditerranée, Faculté de Médecine, 27 Bd Jean Moulin, 13385 Marseille cedex 05, France.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Botelho-Nevers
authors.forename: Clarisse
authors.initials: C
authors.lastname: Rovery
authors.forename: Hervé
authors.initials: H
authors.lastname: Richet
authors.forename: Didier
authors.initials: D
authors.lastname: Raoult
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D001907:Boutonneuse Fever / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D024841:Fluoroquinolones / Q000008:administration & dosage* / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020114:Rickettsia conorii / Q000472:pathogenicity*; D012307:Risk Factors; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones