Address for correspondence: James E. Childs, Sc. D., Viral & Rickettsial Zoonoses Branch, National Center for Infectious Diseases, Centers for Disease Control and Prevention, MS G-13, 1600 Clifton Road, Atlanta, GA 30333. Voice: 404-639-1075; fax: 404-639-4436.
jfc5{at}cdc.gov
Ann. N.Y. Acad. Sci. 990: 295-301 (2003).
Rocky Mountain spotted fever (RMSF), a tick-borne illness that
has its highest incidence in the south central and southeastern
United States, is often a diagnostic challenge, as patients
frequently present with nonspecific symptoms during the early
stages of illness. RMSF has a high case fatality rate among
untreated individuals, and the median time from onset of symptoms
to death is only eight days, making early recognition and treatment
of RMSF crucial. In two Mississippi public health districts,
148 primary care physicians were randomly selected and mailed
surveys regarding RMSF diagnosis, treatment, and prevention.
Eighty-four of the 148 (57%) physicians responded. Responses
from different specialties and different health districts were
compared using chi square statistics. Almost all (99%) physicians
correctly identified doxycycline as the antibiotic agent of
choice for treating adults and adolescents. However, only 21%
of family practice physicians, and 25% of emergency medicine
physicians correctly identified the antibiotic of choice for
treating children with RMSF. Twenty-three percent of physicians
responded that waiting for the development of a rash before
prescribing antibiotics is an appropriate treatment strategy.
The current standard of care—doxycycline as the agent
of choice among children 8 years of age or younger with suspected
RMSF—has not been effectively communicated to all physicians
caring for children. Also, many physicians are not familiar
with the rationale underlying initiation of antibiotic therapy
prior to the development of rash in patients with suspected
RMSF. Continuing education efforts should focus on antibiotic
selection in pediatric patients and initiation of therapy prior
to the onset of rash in appropriate patients.
