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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 infection

  • 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

Infection control precautions

  • 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