Editing Rocky Mountain spotted fever (section)

==Treatment==
Appropriate [[antibiotic]] treatment should be started immediately when there is a suspicion of Rocky Mountain spotted fever.<ref name=Koy2018 /> Treatment should not be delayed for laboratory confirmation of disease as early initiation of treatment of Rocky Mountain spotted fever is associated with lower mortality.<ref name="AAFP Pace">{{cite journal |last1=Pace |first1=EJ |last2=O'Reilly |first2=M |title=Tickborne Diseases: Diagnosis and Management. |journal=American Family Physician |date=1 May 2020 |volume=101 |issue=9 |pages=530–540 |pmid=32352736}}</ref> Failure to respond to a [[tetracycline]] argues against a diagnosis of Rocky Mountain spotted fever. Severely ill people may require longer periods before their fever resolves, especially if they have experienced damage to multiple organ systems. Preventive therapy in healthy people who have had recent tick bites is not recommended and may only delay the onset of disease.<ref>{{cite journal |vauthors=Gammons M, Salam G |title=Tick removal |journal=Am Fam Physician |volume=66 |issue=4 |pages=643–5 |date=August 2002 |pmid=12201558 |url=http://www.aafp.org/afp/2002/0815/p643.html}}</ref>

[[Doxycycline]] (a tetracycline) is the drug of choice for patients with Rocky Mountain spotted fever. According to the CDC,<ref name="cdc">{{cite web |date=2018-10-26 |title=Rocky Mountain Spotted Fever |url=https://www.cdc.gov/rmsf/ |publisher=Centers for Disease Control and Prevention}}</ref> "Doctors often avoid prescribing doxycycline to young children because of a warning that tooth staining may occur when used in children less than 8 years old. ..Misperceptions about the use of doxycycline for children prevent kids from getting lifesaving treatment" of rickettsial diseases. "Delay in treatment of rickettsial diseases may lead to severe illness or death. Children are five times more likely than adults to die from RMSF." A 2013 study shows that "short courses of…doxycycline can be used in children without causing tooth staining or weakening of tooth enamel."<ref name=":0">{{Cite web |last=CDC |date=2019-02-19 |title=Research on doxycycline {{!}} CDC |url=https://www.cdc.gov/rmsf/doxycycline/index.html |access-date=2022-04-13 |website=Centers for Disease Control and Prevention |language=en-us}}</ref> The CDC observed that "clearer language on the drug label may help avoid hesitation in prescribing life-saving doxycycline to children."<ref name=":0" />

Treatment typically consists of 100 milligrams every 12 hours, or for children under {{convert|45|kg|abbr=on}} at 4&nbsp;mg/kg of body weight per day in two divided doses. Treatment should be continued for at least three days after the fever subsides, and until there is unequivocal evidence of clinical improvement. This will be generally for a minimum time of five to ten days.<ref name="Koy2018" /> Severe or complicated outbreaks may require longer treatment courses. [[Chloramphenicol]] is an alternative drug that can be used to treat Rocky Mountain spotted fever, specifically in pregnancy. However, this drug may be associated with a wide range of side effects, and careful monitoring of blood levels is required.<ref name="Koy2018" />