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Proposed mechanisms and preventative options of Jarisch-Herxheimer reactions

M W Pound1, D B May

  • 1Department of Pharmacy Practice, Campbell University School of Pharmacy, Buies Creek, NC 27506, USA. mpound@capefearvalley.com

Journal of Clinical Pharmacy and Therapeutics
|May 18, 2005
PubMed
Abstract

Insights

The Jarisch-Herxheimer reaction (JHR) often occurs during spirochete infection treatment. While its exact cause is unclear, anti-tumour necrosis factor antibodies show promise in prevention.

Area of Science:

  • Medical Microbiology
  • Immunology
  • Pharmacology

Background:

  • The Jarisch-Herxheimer reaction (JHR) is an acute, systemic inflammatory response.
  • It commonly occurs following the initiation of antibiotic treatment for spirochetal infections.

Purpose of the Study:

  • To review the known causes (aetiologies) of Jarisch-Herxheimer reactions (JHR).
  • To explore potential methods for preventing JHR.

Main Methods:

  • A comprehensive literature search was conducted using Ovid Medline from 1966 to June 2004.
  • Bibliographies of relevant articles were also reviewed to identify additional studies.

Main Results:

  • Jarisch-Herxheimer reactions (JHR) are frequently observed during the treatment of infections caused by spirochetes.
  • The precise mechanism underlying JHR remains incompletely understood.
  • Conflicting evidence suggests JHR may be linked to endotoxin-like material release from spirochetes and elevated cytokine levels.

Conclusions:

  • The drug type and spirochete clearance rate appear to have minimal impact on JHR incidence.
  • Various pretreatment strategies have been investigated with limited success.
  • Anti-tumour necrosis factor antibodies represent a promising preventative option for JHR.

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