Doxycycline use for rickettsial disease in pediatric patients.

BACKGROUND: Recent evidence suggests that despite potential side effects, doxycycline should be considered the drug of choice for children of all ages in whom a rickettsial disease is considered in the differential diagnosis of the illness. We hypothesized that doxycycline would be used infrequently for the treatment of suspected rickettsial disease. The objective of the investigation was to determine the initial antibiotic administered to children for whom rickettsial infection was considered likely.

METHODS: The study population consisted of 35 children evaluated at Texas Children's Hospital between 1987 and 1999 in whom rickettsial disease was a diagnostic consideration. Demographic information and clinical manifestations were assessed through a retrospective chart review.

RESULTS: Thirty children (86%) presented with fever, 21 (60%) with rash and 14 (40%) with headache, which are typical presenting symptoms for rickettsial diseases. Only 1 of 35 children (3%) was prescribed a tetracycline class antibiotic as initial empiric therapy. Eleven (31%) children received doxycycline during the hospital course. A total of 19 patients, or 54%, received an antimicrobial known to have efficacy in the treatment of rickettsial infection, usually at the suggestion of an infectious diseases consultant.

CONCLUSIONS: Even among children for whom rickettsial infection is a diagnostic consideration, doxycycline is not prescribed with the frequency that is indicated. Pediatric caregivers should have heightened awareness regarding the appropriate indications for doxycycline use in childhood.