Treatment of Rat Bite Fever in a Patient with Penicillin Allergy

Clinical Scenario

Rat bite fever (Streptobacillosis) in a patient with a history of penicillin allergy — a setting that requires selecting effective antibiotic therapy outside the standard penicillin-based approach.

Treatment Approach

Penicillin allergy in this setting necessitates alternative antibiotic agents. Evidence supports options from other drug classes, though not all commonly considered alternatives have demonstrated consistent success — some have been associated with treatment failures in this population.

The complete drug selection, criteria for considering additional options, and the full structured regimen are available in the protocol below.

Instant Access to Structured Evidence-Based Regimens

References

For penicillin-allergic patients, both streptomycin and tetracycline appear to be effective, but erythromycin use has been associated with treatment failures.

Cephalosporins have also been used successfully and may be considered if cross-allergenicity with penicillin is felt to be unlikely.

DOI: 10.1128/CMR.00016-06

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