Oral Azithromycin Versus Doxycycline in the Treatment of Children With Uncomplicated Scrub Typhus

Kabir, Karthika I.; Jelonnek, J.; Satapathy, Amit Kumar; Sahu, Suchanda; Behera, Bijayini; Padhy, Biswa Mohan

doi:10.1097/inf.0000000000003372

Cited by 6 publications

(7 citation statements)

References 23 publications

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“…Most studies were reported from India ( n =5, 50%). There were five RCTs [ 18 , 21 , 25 – 27 ]. Four studies included only paediatric patients (less than 14-18 years) [ 21 , 22 , 24 , 25 ].…”

Section: Resultsmentioning

confidence: 99%

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Doxycycline vs azithromycin in patients with scrub typhus: a systematic review of literature and meta-analysis

Gupta,

Boodman,

Jouego

et al. 2023

BMC Infect Dis

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Introduction Scrub typhus is a bacterial mite-borne disease associated with poor clinical outcomes if not treated adequately. The study aimed to compare the time to defervescence, clinical failure, mortality and treatment-related adverse effects of two common drugs (doxycycline and azithromycin) used for its treatment. Methodology This was a systematic review and meta-analysis. All studies up to 20.03.2023 were screened for eligibility in Pubmed and Embase using a search string containing terms related to scrub typhus, doxycycline and azithromycin. After two phases of screening, all comparative studies where doxycycline and azithromycin were used to treat scrub typhus were included. The studies were critically appraised using standardised tools, and a meta-analysis was performed for time to defervescence (primary outcome), clinical failure, mortality and treatment-related adverse effects. Results Of 744 articles from two databases, ten were included in the meta-analysis. All but two studies had a high risk of bias. The meta-analysis for time to defervescence had a high heterogeneity and did not show any significant difference between doxycycline and azithromycin arms [Mean difference of -3.37 hours (95%CI: -10.31 to 3.57), p=0.34]. When the analysis was restricted to studies that included only severe scrub typhus, doxycycline was found to have a shorter time to defervescence [mean difference of -10.15 (95%CI: -19.83 to -0.46) hours, p=0.04]. Additionally, there was no difference between the two arms concerning clinical failure, mortality and treatment-related adverse effects. Conclusion The current data from studies with a high risk of bias did not find statistically significant differences in clinical outcomes between doxycycline and azithromycin for scrub typhus

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Section: Resultsmentioning

confidence: 99%

“…There were five RCTs [ 18 , 21 , 25 – 27 ]. Four studies included only paediatric patients (less than 14-18 years) [ 21 , 22 , 24 , 25 ]. The remaining six incorporated either adults or individuals of any age.…”

Section: Resultsmentioning

confidence: 99%

Doxycycline vs azithromycin in patients with scrub typhus: a systematic review of literature and meta-analysis

Gupta,

Boodman,

Jouego

et al. 2023

BMC Infect Dis

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“…Our study results are in sync with the published literature. [11][12][13] In a recent open-label RCT conducted on uncomplicated scrub typhus, 13 no significant difference was observed between children who achieved fever remission after receiving AZ compared with those treated with DX. Patients who did not achieve defervescence after 72 hours of the interventional drug were labeled as treatment failure cases and were switched over to the alternate drug, but the outcome of these cases was not mentioned.…”

Section: Discussionmentioning

confidence: 99%

“…A recent study in children with uncomplicated scrub typhus showed equal efficacy of DX and AZ. 13 Thus, there was limited but promising data regarding the efficacy of AZ for the treatment of pediatric scrub typhus. We hypothesized that AZ (10 mg/kg/day for 5 days) was noninferior to DX (2.2 mg/kg/dose BD for weight <40 kg and 100 mg BD for weight >40 kg for 7 days) for achieving defervescence in hospitalized children 1–14 years old suffering from scrub typhus.…”

mentioning

confidence: 99%

Open-labeled Randomized Controlled Trial on Efficacy of Azithromycin Versus Doxycycline in Pediatric Scrub Typhus

Sharma,

Mahajan,

Guglani

et al. 2023

Pediatric Infectious Disease Journal

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Background: Doxycycline (DX) is the first-line therapeutic agent for scrub typhus. Macrolides, especially azithromycin (AZ), have been found to be equally efficacious as DX for treating scrub typhus in adults. We conducted this study to compare the efficacy of AZ versus DX in pediatric scrub typhus. Study design: Open-label randomized controlled trial. Methods: Children 1–14 years of age suffering from acute febrile illness of ≥5 days and with a positive scrub IgM serology were randomized to receive either DX (2.2 mg/kg/dose twice daily in <40 kg; 100 mg BD in >40 kg for 7 days) or AZ (10 mg/kg/day for 5 days). The primary outcome was defervescence within 7 days of DX or 5 days of AZ. Results: We had 75 children randomized and analyzed using an intention-to-treat approach and 60 children analyzed via per-protocol analysis. The proportion of children achieving defervescence was comparable in 2 groups [per-protocol analysis: 90.9% in the DX group vs. 96.3% in the AZ group, RR: 0.94 (95% CI: 0.83–1.08)]. On Kaplan–Meier curves, AZ showed a significantly higher probability of defervescence at any time point during treatment as compared with DX (log-rank test P value 0.035). Conclusion: AZ and DX had comparable rates of defervescence among children with scrub typhus. Trial registration No.: CTRI/2020/01/022991.

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“…This is consistent with the adverse reaction rate (8.6%) described in a recent trial of doxycycline for the treatment of scrub typhus in children less than 13 years old, largely due to gastrointestinal symptoms. 7 Administering oral doxycycline with food may prevent these symptoms.…”

Section: Discussionmentioning

confidence: 99%

Doxycycline for the Treatment of Lyme Disease in Young Children

Brown,

Corin,

Handel

2023

Pediatric Infectious Disease Journal

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Background: Doxycycline is considered the first-line treatment of Lyme disease in adolescents and adults, but largely disproven concerns of permanent tooth staining prevented its use and evaluation in children <8 years old. We sought to describe short-term adverse effects and treatment failures among young children receiving oral doxycycline for Lyme disease. Methods: We completed a 2-pronged evaluation of children with Lyme disease treated with doxycycline. We performed a retrospective case series of patients <8 years old who were diagnosed with Lyme disease and treated with doxycycline. We then performed a telephone follow-up survey study of the patients’ parents to gather additional details regarding clinical outcomes and adverse reactions to doxycycline. Descriptive statistics were calculated. Results: A total of 32 patients were identified through the retrospective case series and 18 participated in the follow-up survey. The most common clinical diagnosis (22/32; 69%) was single erythema migrans. Seven (22%) had neurological Lyme disease. Three patients (9%) stopped doxycycline treatment prematurely due to adverse effects. During telephone follow-up, 2 children were reported to have dental staining. No patients were identified with treatment failure during the retrospective case series. On telephone follow-up, 3 patients had residual symptoms after treatment, though none were convincing of treatment failure. Conclusions: Our study suggests that doxycycline is generally well-tolerated and an effective treatment of Lyme disease in young children. Prospective, observational studies with long-term assessment of dental staining and clinical outcomes are needed. Alternative antibiotics, principally amoxicillin, remain the preferred treatment of non-neurological Lyme disease manifestations in young children, but doxycycline is likely a safe and effective alternative when needed.

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Oral Azithromycin Versus Doxycycline in the Treatment of Children With Uncomplicated Scrub Typhus

Cited by 6 publications

References 23 publications

Doxycycline vs azithromycin in patients with scrub typhus: a systematic review of literature and meta-analysis

Doxycycline vs azithromycin in patients with scrub typhus: a systematic review of literature and meta-analysis

Open-labeled Randomized Controlled Trial on Efficacy of Azithromycin Versus Doxycycline in Pediatric Scrub Typhus

Doxycycline for the Treatment of Lyme Disease in Young Children

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