Treatment

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Most leptospirosis cases are mild and resolve spontaneously (1)

• early initiation of antimicrobial therapy may prevent some patients from progressing to more severe disease.

Penicillin or tetracylines should be given within the first 5 days of the illness

• therapy for patients with leptospirosis severe enough to merit hospitalization usually involves intravenous penicillin (1.5 million units IV every 6 h), ampicillin (0.5-1 g IV every 6 h), ceftriaxone (1 g IV every 24 h), or cefotaxime (1 g IV every 6 h) (1)
• adult outpatients with early disease should receive either doxycycline 100 mg orally twice per day or azithromycin 500 mg orally once per day (1)

Further management is supportive with special attention to fluid balance and the possible need for renal replacement therapy.

Doxycycline is a useful prophylaxis that may be given to high risk groups.

Reference:

• Haake DA, Levett PN. Leptospirosis in humans. Curr Top Microbiol Immunol. 2015;387:65-97