Q Fever: Treatment Overview for Clinicians

Acute infection

Doxycycline is the treatment of choice for acute Q fever.
A dose of 100 mg of doxycycline taken orally twice daily for 15-21 days is a frequently prescribed therapy for adults.
Quinolone antibiotics have demonstrated good in vitro activity against C. burnetii and may be considered by the physician.
Antibiotic treatment is most effective when initiated within the first 3 days of illness.
Doxycycline therapy should be started again if the patient relapses.
Although Q fever infection during pregnancy carries a high risk for adverse outcome, doxycycline is contraindicated during pregnancy. Pregnant women should be treated through delivery with co-trimoxazole (320 mg trimethoprim and 1600 mg sulfamethoxazole daily).
Doxycycline is usually contraindicated in children less than 8 years of age, however in the case of acute Q fever this drug can be given (2.2mg/kg twice a day). Co-trimoxazole is a possible second-line treatment for young children.

Chronic Q fever endocarditis is much more difficult to treat effectively and often requires the use of multiple drugs. Two different treatment protocols have been evaluated:
- doxycycline in combination with quinolones for at least 4 years and
- doxycycline in combination with hydroxychloroquine for 1.5 to 3 years.
The second therapy leads to fewer relapses, but requires routine eye exams to detect accumulation of chloroquine.
Surgery to replace damaged valves may be required for some cases of C. burnetii endocarditis

Persons with acute or chronic Q fever should be cared for using standard precautions. These patients are not usually considered infectious to other persons, and special precautions are not required for routine care.
- C. burnetii is shed in milk, and infected women may pose a risk of transmission to their nursing infants.
- Person-to-person transmission should be considered a possibility for medical personnel performing obstetrical procedures on infected pregnant women.
- Patients may pose a risk for transmission of C. burnetii to sex partners during acute illness.
- For more information, see Guideline for Isolation Precautions in Hospitals