A 30-year-old man has 3 days of fever, myalgia, and headache after wading through floodwater. He is haemodynamically stable, non-icteric, and has normal renal function. Leptospirosis is suspected. Which is the recommended treatment for this mild, uncomplicated illness?
- A Oral ciprofloxacin
- B Intravenous crystalline penicillin G
- C Oral doxycycline ✓
- D Intramuscular streptomycin
Correct answer: C. Oral doxycycline
Explanation
Harrison recommends oral doxycycline for mild leptospirosis and parenteral penicillin G or ceftriaxone only for severe disease such as Weil syndrome, meningitis, or myocarditis. This patient has no organ dysfunction, so intravenous penicillin G is unnecessary rather than wrong in principle, but the standard answer for mild disease is doxycycline. Streptomycin has no role, and fluoroquinolones are not first line.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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