Jarisch-Herxheimer Reaction Severity Assessment
Acute febrile reaction occurring within 24 h of antibiotic treatment for spirochaete infections (syphilis, leptospirosis, Lyme, relapsing fever). Categorise severity for management.
Score interpretation
→ Continue treatment. Antipyretics (paracetamol), oral fluids, observation. Reassure: typically self-limiting within 24 h. Symptoms peak at 6–8 h.
→ Admission for observation. IV fluids, paracetamol; corticosteroids (e.g. prednisolone 60 mg) controversial — generally NOT recommended outside neurosyphilis/cardiovascular syphilis. Continue antibiotics.
→ Critical care. Aggressive fluid resuscitation, vasopressors if needed. IV methylprednisolone 1 mg/kg may be considered. Continue antibiotics — interrupting risks worsening untreated spirochaetosis. Cardiac and respiratory monitoring.
→ Continuous fetal monitoring. Treat maternal fever aggressively (paracetamol, cooling). Steroids in syphilis treatment in 2nd/3rd trimester (prednisolone 20 mg TDS for 3 days starting 24 h before penicillin). Joint obstetric and ID care.
Interpretation bands for the Jarisch-Herxheimer. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
- Demeclocycline hydrochloride · Tetracycline antibiotic / off-label SIADH treatment
- Metronidazole (Bacterial Vaginosis) · Antibiotic (Nitroimidazole) — BV Treatment
- Azithromycin (Chlamydia / STI in Pregnancy) · Macrolide Antibiotic — STI Treatment
- Bleomycin (Intralesional — Keloid/Wart Treatment) · Cytotoxic Antibiotic — Intralesional Use (Sclerotherapy)
- Doxycycline 100mg (Acne / Rosacea) · Oral tetracycline antibiotic (anti-acne / anti-rosacea)
- Lymecycline 408mg (Acne) · Oral tetracycline antibiotic (anti-acne)
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.