Penicillin at the late stage of leptospirosis: a randomized controlled trial

Authors

  • Everaldo Costa Hospital Couto Maia
  • Antonio Alberto Lopes Universidade Federal da Bahia; Faculdade de Medicina; Hospital Universitário Professor Edgard Santos; Núcleo de Epidemiologia Clínica
  • Edilson Sacramento Hospital Couto Maia
  • Yara Aragão Costa Hospital Couto Maia
  • Eliana Dias Matos Fundação Otávio Mangabeira
  • Marcelo Barreto Lopes Universidade Federal da Bahia; Faculdade de Medicina
  • José Carlos Bina Hospital São Rafael

Keywords:

Leptospirosis, Case-fatality rate, Prognosis, Death rate, Penicillin, Randomized clinical trial, Weil's Disease

Abstract

There is evidence that an early start of penicillin reduces the case-fatality rate of leptospirosis and that chemoprophylaxis is efficacious in persons exposed to the sources of leptospira. The existent data, however, are inconsistent regarding the benefit of introducing penicillin at a late stage of leptospirosis. The present study was developed to assess whether the introduction of penicillin after more than four days of symptoms reduces the in-hospital case-fatality rate of leptospirosis. A total of 253 patients aged 15 to 76 years with advanced leptospirosis, i.e., more than four days of symptoms, admitted to an infectious disease hospital located in Salvador, Brazil, were selected for the study. The patients were randomized to one of two treatment groups: with intravenous penicillin, 6 million units day (one million unit every four hours) for seven days (n = 125) and without (n = 128) penicillin. The main outcome was death during hospitalization. The case-fatality rate was approximately twice as high in the group treated with penicillin (12%; 15/125) than in the comparison group (6.3%; 8/128). This difference pointed in the opposite direction of the study hypothesis, but was not statistically significant (p = 0.112). Length of hospital stay was similar between the treatment groups. According to the results of the present randomized clinical trial initiation of penicillin in patients with severe forms of leptospirosis after at least four days of symptomatic leptospirosis is not beneficial. Therefore, more attention should be directed to prevention and earlier initiation of the treatment of leptospirosis.

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Published

2003-06-01

Issue

Section

Leptospirosis

How to Cite

Costa, E., Lopes, A. A., Sacramento, E., Costa, Y. A., Matos, E. D., Lopes, M. B., & Bina, J. C. (2003). Penicillin at the late stage of leptospirosis: a randomized controlled trial . Revista Do Instituto De Medicina Tropical De São Paulo, 45(3), 141-145. https://revistas.usp.br/rimtsp/article/view/30701