Treatment of Streptobacillosis in Adults (Age ≥18) with Rat Bite Fever — Not Penicillin-Allergic

This protocol covers adult patients aged 18 years or older presenting with rat bite fever who have no allergy to penicillin. Penicillin-allergy status is the pivotal determinant of the antibiotic pathway in this setting.

Clinical Scenario

Adult (age ≥18) with confirmed or suspected rat bite fever, not penicillin-allergic. This non-allergic status opens the primary treatment pathway, and the clinical response within the first two days informs whether dose adjustment is required.

Treatment Approach

Management is built around intravenous penicillin G. The protocol specifies distinct dosing tiers based on the patient’s early clinical response — the complete escalation criteria, duration, and decision points are available in the full structured regimen.

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References

DOI: 10.1128/CMR.00016-06

Adults with rat bite fever should receive 400,000 to 600,000 IU/day (240 to 360 mg) of intravenous penicillin G for at least 7 days, but this dose should be increased to 1.2 million IU/day (720 mg) if no response is seen within 2 days.

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