Version June 2024
| Drug | Adult dosing | Pediatric dosing |
| Severe illness* | ||
| Streptomycin¶ | 10 mg/kg intramuscularly every 12 hours for 7 to 10 days (maximum daily dose 2 g) | 30 to 40 mg/kg per day intramuscularly, in divided doses every 12 hours for 7 to 10 days (maximum daily dose 2 g)Δ |
| Gentamicin◊ | 5 mg/kg intramuscularly or intravenously daily, divided every 8 hours for 7 to 10 days | 5 mg/kg intramuscularly or intravenously daily, divided every 8 or 12 hours for 7 to 10 daysΔ |
| Mild or moderate illness§ | ||
| Doxycycline | 100 mg orally twice daily for 14 to 21 days¥ | Doxycycline is not recommended for treatment of tularemia in children |
| Ciprofloxacin‡ | 500 to 750 mg orally twice daily for 10 to 14 days | 20 to 40 mg/kg per day orally divided two doses for 10 to 14 days (maximum daily dose 1 g)§ |
* For patients with meningitis, intravenous combination therapy is administered with an aminoglycoside plus either ciprofloxacin or doxycycline. The duration of treatment is generally 14 to 21 days, depending on clinical response. Chloramphenicol is an alternative agent to use in combination with an aminoglycoside, but it is not widely available. It is dosed 15 to 25 mg/kg intravenously four times daily for adults and 15 mg/kg intravenously four times daily for children, with a maximum daily dose of 4 g.
¶ Dosing for streptomycin must be adjusted according to serum concentrations for individuals with renal insufficiency, individuals over age 50 years, and for pediatric patients. Target serum streptomycin concentrations for intramuscular administration are trough <10 mcg/mL and peak up to 20 to 25 mcg/mL. For adults patients who are very ill, streptomycin 15 mg/kg every 12 hours may be administered. Streptomycin is more ototoxic than other aminoglycosides and audiometric testing is warranted for situations in which serum concentration monitoring is warranted. For obese patients, dosing should be determined based on adjusted weight. (Refer to Calculator on ideal body weight (method of Devine) and dosing weight.)
Δ Gentamicin is the preferred aminoglycoside for children, and the usual duration of gentamicin therapy in children is 10 days.
◊ Dosing for gentamicin must be adjusted according to serum concentrations for individuals with renal insufficiency, individuals over age 50 years, and for pediatric patients. For pediatric patients, adjust the dose of gentamicin to maintain a peak serum concentration of at least 5 mcg/mL. For adults with normal renal function, once-daily dosing of gentamicin is also acceptable. For obese patients, dosing should be determined based on adjusted weight. (Refer to Calculator on ideal body weight (method of Devine) and dosing weight.)
§ Initial oral treatment is reasonable for adult patients who can be managed reliably as outpatients and for hospitalized patients without severe disease. For children with mild or moderate infection, we suggest gentamicin, but oral ciprofloxacin is an appropriate alternative for those with mild illness who are expected to complete the prescribed course of treatment. The duration of gentamicin in children with mild disease may be shortened to 5 to 7 days if there is an adequate clinical response and no complications.
¥ Doxycycline is administered for a longer duration than other agents because of a higher risk of relapse with shorter courses.
‡ Levofloxacin has also been used successfully, although there is more clinical experience with ciprofloxacin, and the optimal dose is uncertain.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
