Aminoglycosides: Is there an effective alternative in severe tularaemia? A case series

Purpose: Severe pulmonary tularaemia is rare, and evidence guiding optimal antimicrobial treatment remains limited. Although aminoglycosides are commonly recommended, their toxicity profile and practical limitations may complicate treatments. The purpose of this case series was to describe clinical outcomes in adult patients with severe pulmonary tularaemia caused by Francisella tularensis who were treated with fluoroquinolones or tetracyclines.; Methods: We retrospectively describe six adult patients with severe pulmonary tularaemia. Clinical presentation, antimicrobial treatment, and clinical and radiological outcomes were reviewed, with a focus on response to targeted therapy with fluoroquinolones or tetracyclines.; Results: All six patients achieved complete clinical and radiological recovery following targeted antimicrobial therapy with either fluoroquinolones or tetracyclines despite severe pulmonary disease.; Conclusion: This case series provides consistent real-world evidence that fluoroquinolones and tetracyclines can achieve favourable outcomes in severe pulmonary tularaemia. These findings highlight their potential role as alternative treatment strategies and contribute meaningful data to the ongoing discussion on optimal antimicrobial management of tularaemia.