Antibiotic treatment for suspected Rocky Mountain spotted fever usually must be started prior to confirmation of the diagnosis because of the following: (1) currently available laboratory diagnostic methods usually do not allow definitive diagnosis of Rocky Mountain spotted fever until the second week of illness, and (2) delays in the initiation of antimicrobial therapy until confirmation of diagnosis may lead to significant morbidity and mortality, the latter being as high as approximately 25% in untreated cases.1,2 In areas of high incidence, such as North Carolina, a heightened index of suspicion, especially during the season of peak incidence (May through September) means that a large number of patients with compatible signs and symptoms will be treated annually for presumed Rocky Mountain spotted fever.3
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Abramson et al. (1990) studied this question.