RMSF is a potentially life-threatening disease that requires prompt diagnosis and empiric initiation of an appropriate antimicrobial agent. For the clinician treating young children with RMSF, there are few options. The safety and efficacy of fluoroquinolones and orally administered parenteral chloramphenicol have not been established in the pediatric population. Therefore, widespread and casual use of these agents is not recommended. Doxycycline is the most favorable agent for the treatment of RMSF in children younger than 9 years of age because of its documented effectiveness, broader margin of safety, reduced risk of drug-related adverse effects in young children, and convenient dosing schedule. For patients with RMSF reinfection, up to five courses of doxycycline may be administered with minimal risk of dental staining.