Comparison of Doxycycline and Azithromycin for the Treatment of Scrub Typhus in Children

Pachiappan, Natarajan; D, Bahubali Gane

doi:10.14260/jemds/2016/232

jemds

2016

DOI: 10.14260/jemds/2016/232

|View full text |Cite

Comparison of Doxycycline and Azithromycin for the Treatment of Scrub Typhus in Children

Natarajan Pachiappan¹,

Bahubali Gane D²

Abstract: BACKGROUNDScrub typhus is an acute, febrile, infectious illness that is caused by Orientia tsutsugamushi. Doxycycline is a best choice of initial antimicrobial treatment for scrub typhus. The other alternative drug is azithromycin. We conducted this study to compare the efficacy and adverse effects of both the drugs.

Help me understand this report

Search citation statements

Order By: Relevance

Paper Sections

Select...

Citation Types

Supporting

Mentioning

Contrasting

Year Published

2020

2024

Publication Types

Select...

Article3

Relationship

Self Cite0

Independent3

Authors

Journals

Cited by 3 publications

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

Antibiotic Response to Pediatric Scrub Typhus in South India: Is Clinical Failure to Azithromycin to be Worried?

Veerappan

Ramar

Palanisamy

2021

Journal of Tropical Pediatrics

View full text Add to dashboard Cite

Background Scrub typhus is typically associated with a rapid defervescence and clinical improvement within 48 h of initiation of appropriate antibiotics. But increasing reports of resistance to anti-rickettsial medications in scrub typhus are being reported in the literature. Methods This is a retrospective observational study of children up to the age of 14 years admitted between July 2017 and March 2020, to a private medical college hospital in southern part of India. The aim of this study was to compare the clinical response to antibiotic therapy with doxycycline and azithromycin in pediatric scrub typhus infection. Results One hundred thirty-eight children with scrub typhus infection were included for analysis. The median fever control time (h) was 12 (IQR = 6–29) and 24 (IQR = 10–52) with doxycycline and azithromycin respectively (p < 0.001*). Rapid fever control within 48 h was observed in 92% with doxycycline and in 74% with azithromycin (p < 0.001*). The clinical failure rate (defined by the necessity to change the antibiotics due to: (i) worsening of symptoms and signs of scrub typhus despite 48 h of antibiotics or (ii) persistence of fever and other symptoms of scrub typhus beyond 72 h), was significantly less with doxycycline (1%) compared with azithromycin (9.6%). Conclusion There has been a significant delayed clinical response to azithromycin in the treatment of scrub typhus in India, when compared to doxycycline. Hence it is preferable to use doxycycline as the first line of antibiotic for undifferentiated fever in scrub typhus endemic areas. Lay summary This retrospective study aims to compare the clinical response to doxycycline or azithromycin in the treatment of scrub typhus infection in children. The median fever control time, clinical failure rate and the proportion of children with rapid defervescence of fever within 48 h were significantly superior with doxycycline as compared to azithromycin. The findings of this study and those of similar studies in India represent a spectrum of delayed clinical response of Orientia tsutsugamushi to azithromycin as compared to doxycycline in this region.

show abstract

Antibiotic Response to Pediatric Scrub Typhus in South India: Is Clinical Failure to Azithromycin to be Worried?

Veerappan

Ramar

Palanisamy

2021

Journal of Tropical Pediatrics

View full text Add to dashboard Cite

show abstract

<p>Scrub Typhus in Children at Tribhuvan University Teaching Hospital in Nepal</p>

Bajracharya

2020

PHMT

View full text Add to dashboard Cite

Introduction: Scrub typhus is an acute undifferentiated febrile illness with varied nonspecific manifestations. It dramatically responds to appropriate antibiotic if started earlier in the course of disease leading to significant reduction in morbidities and mortalities. Objective: To describe the clinical profile, treatment and prognosis of scrub typhus in children. Patients and Methods: Serologically confirmed children with scrub typhus admitted to Tribhuvan University Teaching Hospital (TUTH) over a period of 3 years (April 15, 2015, to April 14, 2018) were retrospectively analyzed for clinical manifestations, investigations, complications and treatment outcomes. Findings: A total of 84 children (39 boys, 45 girls) were found to have serologically confirmed scrub typhus. Apart from fever which was invariably present in all children, the most common symptoms were that of respiratory system such as shortness of breath, gastrointestinal system which were vomiting and abdomen pain followed by headache. On physical examination, the most frequent clinical signs were hepatosplenomegaly, edema, eschar and lymphadenopathy. Hepatitis, myocarditis and meningitis were the most common complications. Most patients had the shortest defervescence of less than 48 hours with oral doxycycline (64.7%) followed by intravenous chloramphenicol (56.7%). The overall mortality rate was 4.8%, all due to multiorgan dysfunction. Conclusion: In a country like Nepal, scrub typhus should be suspected in any child who presents with fever associated with shortness of breath, abdomen pain, vomiting, headache and clinical findings suggestive of multisystem involvement such as hepatitis, myocarditis or meningitis. Early empirical medical management based on high clinical suspicion while waiting for definitive serological report with oral doxycycline or intravenous chloramphenicol may prevent complications of scrub typhus thereby reducing mortality.

show abstract

Monotherapy is Recommended in the Treatment of Scrub Typhus and Doxycycline Resistance is a Misconception

Chandra,

Chakraborty,

Sil

2024

Bengal Physician Journal

View full text Add to dashboard Cite

scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.

Contact Info

customersupport@researchsolutions.com

10624 S. Eastern Ave., Ste. A-614

Henderson, NV 89052, USA

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Blog Terms and Conditions API Terms Privacy Policy Contact Cookie Preferences Do Not Sell or Share My Personal Information

Made with 💙 for researchers

Part of the Research Solutions Family.

Comparison of Doxycycline and Azithromycin for the Treatment of Scrub Typhus in Children

Cited by 3 publications

References 13 publications

Antibiotic Response to Pediatric Scrub Typhus in South India: Is Clinical Failure to Azithromycin to be Worried?

Antibiotic Response to Pediatric Scrub Typhus in South India: Is Clinical Failure to Azithromycin to be Worried?

<p>Scrub Typhus in Children at Tribhuvan University Teaching Hospital in Nepal</p>

Monotherapy is Recommended in the Treatment of Scrub Typhus and Doxycycline Resistance is a Misconception

Contact Info

Product

Resources

About