Treatment
Appropriate antibiotic treatment should be started immediately when there is a suspicion of Rocky Mountain Spotted Fever on the basis of clinical and epidemiological findings. Treatment should not be delayed until laboratory confirmation is obtained. In fact, failure to respond to tetracycline argues against a diagnosis of Rocky Mountain Spotted Fever. Severely ill patients may require longer periods before their fever resolves, especially if they have experienced damage to multiple organ systems. Preventive therapy in healthy patients who have had recent tick bites is not recommended and may, in fact, only delay the onset of disease.
Doxycycline (tetracycline) (for adults at 100 milligrams every 12 hours, or for children under 45 kg (99 lb) at 4 mg/kg of body weight per day in two divided doses) is the drug of choice for patients with Rocky Mountain Spotted Fever. Treatment should be continued for at least three days after the fever subsides, and until there is unequivocal evidence of clinical improvement. This will be generally for a minimum time of five to ten days. Severe or complicated outbreaks may require longer treatment courses. Doxycycline/ tetracycline is also the preferred drug for patients with ehrlichiosis, another tick-transmitted infection with signs and symptoms that may resemble those of Rocky Mountain Spotted Fever.
Chloramphenicol is an alternative drug that can be used to treat Rocky Mountain spotted fever. However, this drug may be associated with a wide range of side effects, and careful monitoring of blood levels can be required.
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