Penicillin therapy in icteric leptospirosis - abstract

ABSTRACT

The efficacy of antibiotic therapy in icteric (severe) human leptospirosis is unknown. We therefore undertook a prospective, randomized, controlled study of penicilin therapy in such patients. All admitted between October 1, 1983 and June 30, 1986 with a history compatible with leptospirosis, were randomized on admission to receive either 2 megaunits of crystalline pencillin intravenously every six hours for five days or intravenous fluids only. The diagnosis of leptospirosis was confirmed by a four-fold rise in titre or an initial titre> 11600 in the micoagglutination test, and/or by positive leptospira cultures. One hundred and fifty patients were initiated, and leptospirosis was confirmed in seventy-five of them. Seventy-one (94.7 percent) of these were jaundiced. One died before randomization, while four were allergic to penicillin. Thus, thirty-two patients were assigned to receive penicillin, and thirty-four to the control group. A comparison of the results of laboratory tests made on the day of admission revealed no signifcant differences between the two groups. There was no significant difference in time for defervescence, return of biochemical variables to normal, incidence of iritis, or mortality between the two groups. Three patients (8.8 percent) died in the control and one (3.1 percent) in the treatment group. The mortality rate was 5.1 percent for the study and 7 percent overall. Six patients had positive urine cultures in the controls while no cultures were obtained in the treated patients. Penicillin appears to have little effect in icteric leptospirosis (AU)