An Open Randomized Controlled Trial of Desmopressin, and Pulse Dexamethasone as Adjunctive Therapy in Patients with Pulmonary Involvement Associated with Severe Leptospirosis.

Author(s): Niwattayakul K, Kaewtasi S, Chueasuwanchai S, Hoontrakul S, Chareonwat S, Suttinont C, Phimda K, Chierakul W, Silpasakorn S, Suputtamongkol Y

Affiliation(s): Medical Department, Loei Hospital, Loei Province, Thailand.

Publication date & source: 2009-09-02, Clin Microbiol Infect., [Epub ahead of print]

Publication type:

Abstract Pulmonary involvement in leptospirosis is emerging as a common complication associated with severe leptospirosis. A prospective randomized controlled trial of desmopressin or high dose (pulse) dexamethasone as adjunctive therapy in 68 patients with pulmonary involvement associated with severe leptospirosis was conducted between July 2003 and October 2006 at 5 hospitals in Thailand. There were 23 patients in desmopressin group, 22 patients in pulse dexamethasone group, and 23 patients in control group who received standard critical care alone. The diagnosis of leptospirosis was confirmed in 52 patients (76.5%). There were 15 deaths (22.1%), of which 8 patients received desmopressin, 4 patient received pulse dexamethasone and 3 patient was in the control group respectively (P= 0.18). 8 patients with confirmed leptospirosis died (5 patients in desmopressin group, 1 patient in pulse dexamethasone group, and 2 patients in control group). The mortality was not significant different in desmopressin group or pulse dexamethasone group compared to the control group in both intention- to- treat patients, and in patients with confirmed leptospirosis. There were no serious events associated with desmopressin treatment but pulse dexamethasone treatment was associated with a significant increase in nosocomial infection. Results of logistic regression analysis revealed that serum bilirubin level was the only significant risk factor associated with mortality (OR 0.759, 95% CI 0.598-0.965, P=0.024) in this population with severe leptospirosis. In conclusion results of this study did not support the use of either pulse dexamethasone or desmopressin as the adjunctive treatment of pulmonary involvement associated with severe leptospirosis.