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©2013 UpToDate ® Print Email Antibiotics for treatment of tularemia Drug Adult dosing Pediatric dosing Moderate to severe illness Streptomycin 10 mg/kg intramuscularly every 12 hours for 7 to 10 days.* The daily dose should not exceed 2 g. 15 mg/kg per day intramuscularly every 12 hours for 7 to 10 days. The daily dose should not exceed 2 g. Gentamicin 5 mg/kg intramuscularly or intravenously daily•, divided every 8 hours for 7 to 10 days. 2.5 mg/kg intramuscularly or intravenously two or three times daily for 7 to 10 days. Chloramphenicol (for use in the setting of meningitis, in combination with an aminoglycoside) 15 to 25 mg/kg intravenously four times daily for 14 to 21 days. The daily dose should not exceed 4 g. 15 mg/kg intravenously four times daily for 14 to 21 days. The daily dose should not exceed 4 g. Mild illness Doxycycline 100 mg orally twice daily for 14 days. Should be administered to children <8 years of age only if the benefits outweigh the risks. 2 to 4 mg/kg per day orally divided in one or two doses for 14 days. The daily dose should not exceed 200 mg. Ciprofloxacin 500 to 750 mg orally twice daily for 14 days. Not recommended for children <18 years of age. Dosing for streptomycin and gentamicin must be adjusted according to serum concentrations for individuals with renal insufficiency, individuals over age 50, and for pediatric patients. Target serum streptomycin concentrations for IM administration are trough <10 mcg/mL and peak up to 20 to 25 mcg/mL. Streptomycin is more ototoxic than other aminoglycosides and audiometric testing is warranted for situations in which serum concentration monitoring is warranted. For obese patients dosing should be determined based on adjusted weight (See "Calculator: Ideal Body Weight (method of Devine) and Dosing Weight"). * For patients who are very ill, streptomycin 15 mg/kg every 12 hours may be administered. • For adults with normal renal function, once-daily dosing of gentamicin is also acceptable. References: 1. Dennis, DT, Inglesby, TV, Henderson, DA, et al. Tularemia as a biological weapon: medical and public health management. JAMA 2001; 285:2763. 2. American Academy of Pediatrics. Antimicrobial agents and related therapy. In: Red Book: 2012 Report of the Committee on Infectious Diseases, Pickering LK, Baker CJ, Kimberlin DW, Long SS (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2012. p.799.