Rickettsiales: Treatment and management of human disease

When a rickettsiosis is suspected, prompt empiric antibiotic therapy should be initiated. Clinical recognition is key to timely treatment. Early administration of effective antibiotics can quickly abate illness and prevent severe complications. Tetracyclines are the drug class of choice for all these infections, with doxycycline being the preferred agent. Where available, chloramphenicol can be used for spotted fever group rickettsioses, typhus group rickettsioses, and scrub typhus, but the drug is not effective for infections caused by Ehrlichia spp. and Anaplasma phagocytophilum. Other alternative agents are available, but their efficacy against the different genera of this order is not as generalizable as that of tetracyclines.