Clinical Care of Tularemia

Key points

  • Treatment regimens may need to be adjusted depending on a person’s age, medical history, underlying health conditions, pregnancy status, or allergies.
  • Vaccination for tularemia is not generally available in the United States, nor is it useful in management of ill patients.
  • Consult an infectious disease specialist regarding individual patient treatment decisions.
Six bottles of Doxcycline

Treatment recommendations

Tularemia treatment regimen
Age Category Drug Dosage Maximum Duration (Days)
Adults Gentamicin* 5 mg/kg IM or IV daily (with desired peak serum levels of at least 5 mcg/mL) Monitor serum drug levels 10 – 14
Ciprofloxacin* 400 mg IV or 500 mg PO twice daily N/A 10 – 14
Doxycycline 100 mg IV or PO twice daily N/A 14 – 21
Children Gentamicin* 2.5 mg/kg IM or IV 3 times daily** Monitor serum drug levels and consult a pediatric infectious disease specialist 10 – 14
Ciprofloxacin* 15 mg/kg IV or PO twice daily 800 mg per day 10 – 14
Doxycycline 2.2 mg/kg IV or PO twice daily 100 mg IV or PO twice daily 14 – 21
* Not a U.S. FDA-approved use but has been used successfully to treat patients with tularemia.
** Once-daily dosing could be considered in consultation with a pediatric infectious disease specialist and a pharmacist.

NOTE: Gentamicin is preferred for treatment of severe tularemia. Dose should be adjusted for renal insufficiency.

NOTE: For tularemia meningitis, combination therapy should be considered in consultation with an infectious disease specialist.

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Content Source:
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)