What are the primary antibiotics used for tularemia treatment?

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Tularemia is caused by Francisella tularensis, an intracellular bacterium, so the antibiotic chosen needs to penetrate cells effectively and act quickly to clear the infection. Aminoglycosides, specifically streptomycin and gentamicin, are the primary first-line treatments because they achieve reliable intracellular activity and have a long track record of successful outcomes in tularemia. Streptomycin has long been the standard, and gentamicin offers comparable efficacy with practical dosing options, making them the go-to choices in most clinical guidelines.

Doxycycline and ciprofloxacin can be used as alternatives, especially for mild disease or when aminoglycosides can’t be used, but they are associated with higher relapse rates in some forms of tularemia and may not be as reliably curative for severe disease. Penicillin V is not effective against Francisella tularensis, and aztreonam is not an appropriate treatment for tularemia because the organism is inherently resistant to that drug class.