Effectiveness of Antibiotic Prophylaxis for Leptospirosis among Adults: A Systematic Review

Muhammad Aklil Abd Rahim; Aznida Mohamad Zaki; Azman Atil; Muhammad Haneef Azme; Nik Ahmad Shaiffudin Nik Him; Syed Sharizman Syed Abdul Rahim; Mohammad Saffree Jeffree; Norfazilah Ahmad; Mohd Rohaizat Hassan

Muhammad Aklil Abd Rahim Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Selangor, Malaysia
Aznida Mohamad Zaki Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Selangor, Malaysia
Azman Atil Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Selangor, Malaysia
Muhammad Haneef Azme Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Selangor, Malaysia
Nik Ahmad Shaiffudin Nik Him Faculty of Medicine, Universiti Sultan Zainal Abidin, Jalan Sultan Mahmud 20400 Kuala Terengganu, Terengganu, Malaysia
Syed Sharizman Syed Abdul Rahim b Department of Community and Family Medicine, Universiti Malaysia Sabah, Jalan UMS, 88400 Kota Kinabalu, Sabah, Malaysia
Mohammad Saffree Jeffree Department of Community and Family Medicine, Universiti Malaysia Sabah, Jalan UMS, 88400 Kota Kinabalu, Sabah, Malaysia
Norfazilah Ahmad Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Selangor, Malaysia
Mohd Rohaizat Hassan Department of Community Health, Faculty of Medicine, University Kebangsaan Malaysia

Abstract

Leptospirosis is one of the most widespread re-emerging zoonoses in the world. Malaysia is known to be an endemic country for human leptospirosis, with a case fatality rate of 2.11%, and an average annual incidence rate of 7.80 cases per 100,000 individuals. This systematic review is conducted to determine the effectiveness of antibiotic prophylaxis for leptospirosis among the adult populations who are highly at risk of getting infected. A systematic search was performed for the relevant titles, abstracts and keywords on PubMed, Scopus, Cochrane and Google Scholar from inception to November 2017 based on the PICO strategy; which returned 126 studies. Screening of abstracts had shortlisted 19 studies and data extraction was conducted for 8 studies which had been accepted after review of the full text. For the evaluation of antibiotics prophylaxis effectiveness against leptospirosis, only trials and cohort studies with risk ratio (RR) were selected. The articles were analyzed from the viewpoint of the dosage, adverse effects, study settings and effectiveness of the antibiotic prophylaxis. Using fixed effects model, pooled RR showed protective association between antibiotic prophylaxis use against the incidence of leptospirosis (RR = 0.31; 95% CI: 0.20, 0.48). Antibiotic prophylaxis for leptospirosis had been shown to be effective in preventing the incidence of the disease among high-risk populations and carries minimal adverse effects. It is recommended that the practice of antibiotic prophylaxis for leptospirosis is included in the standard protocol for leptospirosis prevention among people at high-risk, including disaster response teams and patrons of eco-sports tourism activities; with the drug of choice being doxycycline, either as a single 200 mg dose or weekly dose of 200 mg for the duration of exposure, based on the setting, duration of event and resources available.

References

Benacer, D., Thong, K. L., Min, N. C., Bin Verasahib, K., Galloway, R. L., Hartskeerl, R. A., . . . Mohd Zain, S. N. (2016). Epidemiology of human leptospirosis in Malaysia, 2004-2012. Acta Trop, 157, 162-168. doi: 10.1016/j.actatropica.2016.01.031

Chusri, S., McNeil, E. B., Hortiwakul, T., Charernmak, B., Sritrairatchai, S., Santimaleeworagun, W., . . . Jarman, R. G. (2014). Single dosage of doxycycline for prophylaxis against leptospiral infection and leptospirosis during urban flooding in southern Thailand: a non-randomized controlled trial. J Infect Chemother, 20(11), 709-715. doi: 10.1016/j.jiac.2014.07.016

Costa, F., Hagan, J. E., Calcagno, J., Kane, M., Torgerson, P., Martinez-Silveira, M. S., . . . Ko, A. I. (2015). Global Morbidity and Mortality of Leptospirosis: A Systematic Review. PLoS Negl Trop Dis, 9(9), e0003898. doi: 10.1371/journal.pntd.0003898

Desai, K. T., Patel, F., Patel, P. B., Nayak, S., Patel, N. B., & Bansal, R. K. (2016). A case-control study of epidemiological factors associated with leptospirosis in South Gujarat region. J Postgrad Med, 62(4), 223-227. doi: 10.4103/0022-3859.188551

Gilks, C. F., Lambert, H. P., Broughton, E. S., & Baker, C. C. (1988). Failure of penicillin prophylaxis in laboratory acquired leptospirosis. Postgrad Med J, 64(749), 236-238.

Gonsalez, C. R., Casseb, J., Monteiro, F. G., Paula-Neto, J. B., Fernandez, R. B., Silva, M. V., . . . Tavares, L. C. (1998). Use of doxycycline for leptospirosis after high-risk exposure in Sao Paulo, Brazil. Rev Inst Med Trop Sao Paulo, 40(1), 59-61.

Guerra, M. A. (2013). Leptospirosis: public health perspectives. Biologicals, 41(5), 295-297. doi: 10.1016/j.biologicals.2013.06.010

Illangasekera, V. L., Kularatne, S. A., Kumarasiri, P. V., Pussepitiya, D., & Premaratne, M. D. (2008). Is oral penicillin an effective chemoprophylaxis against leptospirosis? A placebo controlled field study in the Kandy District, Sri Lanka. Southeast Asian J Trop Med Public Health, 39(5), 882-884.

James, S., Elizabeth, B., Kevin, L. W., Julie, B., Mary, B., Sandra, B., . . . Nancy, R. (2003). Leptospirosis in “Eco-Challenge” Athletes, Malaysian Borneo, 2000. Emerging Infectious Disease journal, 9(6), 702. doi: 10.3201/eid0906.020751

ReviewManager(RevMan). (2014) (Version 5.3). Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration.

Sehgal, S. C., Sugunan, A. P., Murhekar, M. V., Sharma, S., & Vijayachari, P. (2000). Randomized controlled trial of doxycycline prophylaxis against leptospirosis in an endemic area. Int J Antimicrob Agents, 13(4), 249-255.

Smith, J. K., Young, M. M., Wilson, K. L., & Craig, S. B. (2013). Leptospirosis following a major flood in Central Queensland, Australia. Epidemiol Infect, 141(3), 585-590. doi: 10.1017/s0950268812001021

Takafuji, E. T., Kirkpatrick, J. W., Miller, R. N., Karwacki, J. J., Kelley, P. W., Gray, M. R., . . . Sanchez, J. L. (1984). An efficacy trial of doxycycline chemoprophylaxis against leptospirosis. N Engl J Med, 310(8), 497-500. doi: 10.1056/nejm198402233100805

Wahab, Z. A. (2015). Epidemiology and Situational Analysis of Leptospirosis in Malaysia. Prosiding Persidangan Kesihatan Persekitaran Pihak Berkuasa Tempatan 2015.