Adequate for mild disease but extend duration to minimum 14 days
Resistance and intrinsic susceptibility
F. tularensis intrinsically resistant to all beta-lactams
Produces beta-lactamase; also lacks outer membrane beta-lactam binding targets
Most macrolides ineffective (azithromycin exception with some activity)
No acquired antibiotic resistance in wild-type strains reported to date
Theoretical concern for engineered resistance in bioweapon strains
Treatment response monitoring
Clinical improvement expected within 48 hours of appropriate antibiotic therapy
Failure to improve by 72 hours warrants reassessment of diagnosis and regimen
Prolonged delayed treatment (> 2–3 weeks from onset) associated with higher failure and relapse rates
Patient Discharge Instructions
copy discharge instructions
Tularemia discharge instructions
You were treated for tularemia, a bacterial infection caused by Francisella tularensis
This infection is acquired from tick bites, animal contact, or exposure to contaminated water or soil
It is not spread from person to person
Complete your full course of antibiotics as prescribed
Do not stop antibiotics early even if you feel better
Stopping early increases the risk of relapse (return of infection)
Take your medications as prescribed
Ciprofloxacin or doxycycline with food if stomach upset occurs
Stay well hydrated during recovery
Prevention after discharge
Use insect repellent (DEET) and protective clothing in tick-prone areas
Check yourself for ticks after outdoor activities and remove promptly
Avoid handling wild rabbits, rodents, or other small animals without protective gloves
Do not drink untreated water from streams or lakes
Cook wild game thoroughly
Return to the emergency department immediately if you develop
Recurrence of high fever after initial improvement
New or worsening cough, shortness of breath, or chest pain
Confusion, severe headache, or stiff neck
Persistent vomiting, diarrhea, or severe abdominal pain
New skin sores, swollen lymph nodes, or rash
Weakness or dizziness that prevents normal activity
Follow-up appointment
See your physician within 1 week of discharge
A blood test may be repeated to confirm the infection has resolved
Full recovery may take several weeks; fatigue may persist
Report any new exposures to your doctor
Family members or others with the same exposure should be evaluated
References
Guidelines and key sources
2025 CDC MMWR tularemia treatment and prophylaxis guidelines
Nelson CA, Meaney-Delman D, Fleck-Derderian S, Winberg J, Mead PS. Tularemia Antimicrobial Treatment and Prophylaxis: CDC Recommendations for Naturally Acquired Infections and Bioterrorism Response — United States, 2025. MMWR Recomm Rep. 2025. PMID: 41026652
Designates fluoroquinolones as first-line for outbreak scenarios
Updated prophylaxis dosing for special populations
Maurin M, Gyuranecz M. Tularaemia: Clinical Aspects in Europe. Lancet Infect Dis. 2016. PMID: 26738841
Comprehensive European clinical experience and antibiotic outcomes
Relapse rates by antibiotic class
Tularemia as biological weapon (JAMA 2001)
Dennis DT, Inglesby TV, Henderson DA, et al. Tularemia as a Biological Weapon: Medical and Public Health Management. JAMA. 2001. PMID: 11368703
Working group consensus on bioterrorism management
Clinical features, treatment algorithms, mass prophylaxis
Tularemia for clinicians — up to date review (European Journal of Internal Medicine 2025)
Antonello RM, Giacomelli A, Riccardi N. Tularemia for Clinicians: An Up-to-Date Review on Epidemiology, Diagnosis, Prevention and Treatment. Eur J Intern Med. 2025. PMID: 40107886
Current epidemiology, treatment recommendations, and antibiotic outcomes data
Supporting references
Tularemia treatment experimental and clinical data (Frontiers in Microbiology 2023)
Maurin M, Pondérand L, Hennebique A, et al. Tularemia Treatment: Experimental and Clinical Data. Front Microbiol. 2023. PMID: 38298538
Antibiotic mechanism of action and relapse rates
Intrinsic resistance to beta-lactams and macrolides
US surveillance data 2006–2021 (CID 2024)
Wu HJ, Bostic TD, Horiuchi K, et al. Tularemia Clinical Manifestations, Antimicrobial Treatment, and Outcomes: An Analysis of US Surveillance Data, 2006-2021. Clin Infect Dis. 2024. PMID: 38294115
National epidemiology, demographic data, case fatality rates
Tularemia in pediatric patients (Pediatric Infectious Disease Journal 2025)
Kossadoum RF, Baron A, Parizot M, et al. Tularemia in Pediatric Patients: A Case Series and Review of the Literature. Pediatr Infect Dis J. 2025. PMID: 39312633
Pediatric dosing guidance and diagnostic challenges
CDC Tickborne Diseases Manual 6th Edition (2022)
CDC. Tickborne Diseases of the United States: A Reference Manual for Healthcare Providers, 6th Edition. CDC. 2022. https://www.cdc.gov/ticks/media/pdfs/2025/03/tickborne-diseases-manual-508.pdf
Clinical management of bioterrorism-related conditions (NEJM 2015)
Adalja AA, Toner E, Inglesby TV. Clinical Management of Potential Bioterrorism-Related Conditions. N Engl J Med. 2015. PMID: 26131717
Emergency management framework for Category A agents
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.