Streptomycin and alternative agents for the treatment of tularemia: review of the literature. Clin Infect Dis

Because of the recent lack of availability of streptomycin-currently considered the drug of choice for the treatment of tularemia-we reviewed the literature on alternative drugs that have been used for this purpose. In addition, we reviewed data on the in vitro susceptibility of Fran-cisella tularensis to a wide variety of agents. The rate of cure for streptomycin was 97%, with no relapses. For gentamicin and tetracycline, respectively, the rates of cure were 86 % and 88%, the rates of relapse were 6 % and 12%, and the rates of failure were 8 % and O. The duration of therapy with gentamicin and a delay in its initiation may have affected outcome in severe cases. For chloramphenicol and tobramycin, cure rates were 77 % and 50%, respectively; relapse rates were 21 % and 0; and failure rates were 2 % and 33%, respectively. Treatment with imipenemjcilastatin was successful in one case, and that with ciprofloxacin or norfloxacin was successful in six cases; in contrast, therapy with ceftriaxone was ineffective in eight cases. On the basis of this review, we conclude that gentamicin is an acceptable alternative to streptomycin for the treatment of tula-remia. Tularemia, a gram-negative infection caused by Fran-cisella tularensis. was first described in 1925. The clinica