Tularemia

A natural-focal bacterial infection caused by Francisella tularensis; people acquire it through contact with rodents and hares, bites of blood-feeding insects, or inhalation of the organism. Severe disease with high fever and involvement of lymph nodes or lungs needs hospital admission and parenteral therapy.

ICD-10 A211 drug

Also known as: Francisella tularensis infection, Severe tularemia

Drugs used for this condition

AGentamicinFirst line · Aminoglycoside antibioticIn severe tularemia, gentamicin is the preferred first-line aminoglycoside. The most recent CDC guidance (MMWR 2025) names it the drug of choice and advises starting with an aminoglycoside in severe disease, moving streptomycin to third line. A 2024 systematic review reports mortality on aminoglycoside therapy of about 0.7%. In pregnancy, gentamicin is preferred over streptomycin. Treatment is parenteral with monitoring of kidney function.

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit