Table 1.: Treatment of Unusual Infections in the Pleura

Organism First Choice (Duration, d) Alternative Comments
R. rickettsii (RMSF) and R. conorii (MSF) Doxycyline (5-7) [1, 2, 4, 5] Chloramphenicol May be given until 3 days after defervescence
C. burnetii (Q fever) Acute infection
Doxycycline (10-14) [7, 8]
Chronic infection
Doxycyline and hydroxychloroquine (18 months) [8]
Trimethoprim/sulfamethoxazole Clinical cure in chronic infection represents a drop in IgG or IgA phase I antibody titers to 1:200 or less [82]
F.tularensis (tularemia) Streptomycin (7-10) [19, 22, 23] Doxycycline, ciprofloxacin
B. anthracis (anthrax) Ciprofloxacin (60) [27] Doxycycline
Doxycycline plus clindamycin, penicillin or rifampin
Doxycycline alone for cutaneous anthrax; in combination for inhalational, gastrointestinal or soft tissue infection