Yersinia

Preferred antibiotic	Classification for use
Streptomycin 15 mg/kg/d (some authorities would double the dose on the first day) Usually given q12h. IM may be given IV if necessary	Availability an issue Call Pfizer Monitor renal, vestibular, and otic toxicity
Gentamicin 5–7 mg/kg/d Given as 2–3 doses IV	Monitor renal, vestibular, and otic toxicity Monitor blood levels and adjust for renal function
Ciprofloxacin 400 mg q8h IV	Not approved for pediatric use <16 yr
Levofloxacin 750 mg qd IV	Not approved for pediatric use <16 yr
Moxifloxacin 400 mg qd IV	Not approved for pediatric use <16 yr May be preferred in renal failure over other fluoroquinolones
Doxycycline 100 mg q12h IV Some authorities would double the dose on the first day	Not approved for pediatrics ≤8 yr or in pregnancy
Chloramphenicol 1 g (25 mg/kg) IV q6h dose reduction to 500 mg (15 mg/kg) q6h as patient improves	Predominantly for patients with meningitis and children. Meropenem may be an alternative in meningitis

There has been significant success with the use of tetracyclines in therapy of Y. pestis. In recent years doxycycline has been the tetracycline of choice. A randomized trial comparing gentamicin and doxycycline was conducted in Tanzania. The results were equivalent with less than 5% deaths.

A murine bubonic plague model demonstrated ciprofloxacin was as effective as ciprofloxacin plus gentamicin and possibly more effective than gentamicin monotherapy. A recent in vitro pharmacodynamic model evaluated ciprofloxacin, moxifloxacin, gentamicin, ampicillin, and meropenem against streptomycin. All of the drugs out performed streptomycin. There are countervailing in vitro data that streptomycin and ciprofloxacin may be more active against both extracellular and intracellular organisms than either gentamicin or doxycycline. There are mouse data suggesting that levofloxacin-resistant organisms are significantly less fit than streptomycin-resistant organisms. Lastly, there may be nonantibiotic treatments on the horizon. Typical antibiotic courses are 7 to 10 days. Meningitis may require longer therapy.

Yersinia enterocolitica and Yersinia pseudotuberculosis

Yersinia enterocolitica and Y. pseudotuberculosis are most frequently associated with enterocolitis. Infection with Y. enterocolitica occurs much more often than with Y. pseudotuberculosis.

Y. enterocolitica is an important cause of enterocolitis worldwide, especially in colder climates and winter months. This is distinctly different than most enteropathogenic organisms. The frequency of Y. enterocolitica

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