Skip to main content
    • Aa
    • Aa

Assessing cost effectiveness of empirical and prophylactic therapy for managing leptospirosis outbreaks

  • R. L. GALLOWAY (a1), P. N. LEVETT (a2), J. W. TUMEH (a1) and C. R. FLOWERS (a1)

This study evaluates the utility and cost effectiveness of empirical and prophylactic antibiotic treatment of leptospirosis compared with conventional management. We developed decision trees comparing empirical antibiotic treatment (within 4–7 days of symptom onset) or prophylaxis to conventional antibiotic treatment (initiated ⩾7 days post-onset). Costs were calculated using both US and Barbados pricing. Empirical treatment provided slightly lower probability of survival, while prophylactic treatment resulted in slightly higher survival rates. Antibiotic treatment initiated after 4–7 symptomatic days was ineffective in preventing serious health outcomes, but cost less with the exception of azithromycin (US pricing). Empirical treatment in Barbados cost less than conventional treatment. Prophylaxis reduced rare serious health outcomes and resulted in significant cost savings for the United States and Barbados. Prophylactic therapy for high-risk individuals or prompt diagnosis and early treatment (before 4 days of symptoms) appear to be cost-effective approaches to prevent severe complications of leptospirosis.

Corresponding author
*Author for correspondence: R. L. Galloway, 1600 Clifton Road NE, Mailstop G-34, Atlanta, GA 30333, USA. (Email:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

4. PN Levett . Leptospirosis. Clinical Microbiology Reviews 2001; 14: 296326.

5. RC Abdulkader , Leptospirosis severity may be associated with the intensity of humoral immune response. Revista do Instituto de Medicina Tropical de São Paulo 2002; 44: 7983.

15. F Guidugli , AA Castro , AN Atallah . Antibiotics for preventing leptospirosis. Cochrane Database of Systematic Reviews 2000. Issue no. 4. Article no. CD001305.

8. E Costa , Penicillin at the late stage of leptospirosis: a randomized controlled trial. Revista do Instituto de Medicina Tropical de São Paulo 2003; 45: 141145.

11. K Phimda , Doxycycline versus azithromycin for treatment of leptospirosis and scrub typhus. Antimicrobial Agents and Chemotherapy 2007; 51: 32593263.

16. SC Sehgal , Randomized controlled trial of doxycycline prophylaxis against leptospirosis in an endemic area. International Journal of Antimicrobial Agents 2000; 13: 249255.

17. CR Gonsalez , Use of doxycycline for leptospirosis after high-risk exposure in Sao Paulo, Brazil. Revista do Instituto de Medicina Tropical de São Paulo 1998; 40: 5961.

19. ME Griffith , DR Hospenthal , CK Murray . Antimicrobial therapy of leptospirosis. Current Opinion in Infectious Diseases 2006; 19: 533537.

20. F Guidugli , AA Castro , AN Atallah . Systematic reviews on leptospirosis. Revista do Instituto de Medicina Tropical de São Paulo 2000; 42: 4749.

22. G Pappas , A Cascio . Optimal treatment of leptospirosis: queries and projections. International Journal of Antimicrobial Agents 2006; 28: 491496.

28. F Erdinc , Three cases of anicteric leptospirosis from Turkey: mild to severe complications. Journal of Infection 2005; 52: e4548.

41. EF Daher , CB Nogueira . Evaluation of penicillin therapy in patients with leptospirosis and acute renal failure. Revista do Instituto de Medicina Tropical de São Paulo 2000; 42: 327332.

46. TR Jevon , A point-source epidemic of leptospirosis. Description of cases, cause, and prevention. Postgraduate Medicine 1986; 80: 121127–, –122129.

47. JB McClain , Doxycycline therapy for leptospirosis. Annals of Internal Medicine 1984; 100: 696698.

56. JA Hanley , A Lippman-Hand . If nothing goes wrong, is everything all right? Interpreting zero numerators. Journal of the American Medical Association 1983; 249: 17431745.

59. PN Levett , Detection of pathogenic leptospires by real-time quantitative PCR. Journal of Medical Microbiology 2005; 54: 4549.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 4
Total number of PDF views: 29 *
Loading metrics...

Abstract views

Total abstract views: 156 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 25th September 2017. This data will be updated every 24 hours.