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Placebo-controlled trial of intravenous penicillin for severe and late leptospirosis
G Watt1, L P Padre, M L Tuazon
1US Naval Medical Research Unit 2, Manila, Philippines.
Abstract:
The effect of a 7-day course of intravenous penicillin (6 million units/day) on severe, advanced leptospirosis was examined in a randomised, placebo-controlled, double-blind trial involving 42 patients. Every measurable aspect of the disease was favourably affected by penicillin. Fever lasted more than twice as long in the placebo group (11.6 [SD 8.34] days vs 4.7 [4.19] days, p less than 0.005), and by the fourth day after starting penicillin more than half the treatment group, but only 1 of 19 in the placebo group, were afebrile (p less than 0.005). Creatinine rises persisted more than thrice as long in the patients receiving only placebo (8.3 [8.46] days vs 2.7 [1.90] days; p less than 0.01). Penicillin also shortened the hospital stay and prevented leptospiruria. Intravenous penicillin should be given to patients with severe leptospirosis, even if therapy can be begun only late in the course of their disease.
Insights
Intravenous penicillin significantly improves severe leptospirosis outcomes. This antibiotic treatment reduces fever duration, kidney dysfunction, and hospital stays, proving effective even in advanced disease stages.
Area of Science:
- Infectious Diseases
- Bacteriology
- Clinical Medicine
Background:
- Leptospirosis is a severe bacterial infection with significant morbidity.
- Treatment options for advanced leptospirosis are critical.
Purpose of the Study:
- To evaluate the efficacy of intravenous penicillin in severe, advanced leptospirosis.
- To assess the impact of penicillin on key clinical parameters and disease progression.
Main Methods:
- A randomized, placebo-controlled, double-blind trial was conducted.
- 42 patients with severe leptospirosis received either penicillin (6 million units/day) or placebo for 7 days.
Main Results:
- Penicillin significantly reduced fever duration (4.7 vs 11.6 days, p<0.005).
- More patients receiving penicillin became afebrile by day 4 (p<0.005).
- Penicillin shortened the duration of elevated creatinine (2.7 vs 8.3 days, p<0.01) and prevented leptospiruria, reducing hospital stays.
Conclusions:
- Intravenous penicillin is highly effective in treating severe leptospirosis.
- Penicillin administration is recommended for severe leptospirosis, regardless of disease stage at presentation.