is a gram-negative pathogen primarily of animals and occasionally of humans. Tularemia continues to be responsible for significant morbidity and mortality, despite the availability of numerous antibiotics active against the organism (5
). Streptomycin has long been considered the drug of choice for tularemia, but it may be associated with significant side effects. Tetracycline, chloramphenicol, and quinolones are useful alternatives, although relapse rates are higher.
Gentamicin is more widely available and can be given intravenously as an acceptable alternative (3
). Several case reports have shown that gentamicin given as three doses daily for 7 to 10 days has a cure rate of 86%, a relapse rate of 6%, and a failure rate of 8%. In these reports, only 41% of the patients had been on gentamicin monotherapy, or they were treated with shorter courses of therapy (<6 days), or they suffered a delay in the institution of treatment (1
). Although once-daily gentamicin has been recommended, its efficacy has not been reported. Our patients were treated as outpatients with i.v. gentamicin and had complete resolution of symptoms with no relapse and experienced no significant side effects.