Treatment of Infective Endocarditis in Q Fever (Coxiella burnetii)
Clinical Scenario
This protocol addresses blood culture-negative infective endocarditis due to Coxiella burnetii, the causative agent of Q fever. Because Coxiella burnetii is an obligate intracellular pathogen, standard blood cultures remain negative, making targeted serological evaluation essential for diagnosis.
Treatment Approach
Management involves a prolonged course of oral combination therapy with doxycycline and hydroxychloroquine. The complete regimen — including dosing, schedule, and treatment duration — is provided in the full protocol.
Treatment Goals
Success is defined serologically: anti-phase I IgG titres must fall below 1:400, and both IgA and IgM titres must fall below 1:50.
References
DOI: 10.1093/eurheartj/ehad193
- Doxycycline (200 mg/24 h) plus hydroxychloroquine (200–600 mg/24 h) orally (>18 months of treatment)
- Treatment success defined as anti-phase I IgG titre <1:400, and IgA and IgM titres <1:50