What is the treatment of choice for Q fever?

• A. Penicillin
• B. Azithromycin
• C. Doxycycline
• D. Ciprofloxacin

Answer: (C)

Doxycycline is the treatment of choice for acute Q fever because Coxiella burnetii is an intracellular organism, and doxycycline penetrates cells well to inhibit bacterial protein synthesis. The standard approach is 100 mg taken twice daily for about 14 days, often continued for 24 hours after fever resolves. Penicillin doesn’t effectively reach the intracellular niche of Coxiella, so it’s not preferred. Azithromycin can be used if doxycycline isn’t suitable, but it’s not as reliably effective for acute Q fever. Ciprofloxacin is not the best choice due to limited activity against Coxiella burnetii. For chronic Q fever (e.g., endocarditis), therapy would be longer and typically includes doxycycline plus another agent, but the acute treatment of choice remains doxycycline.