Scrub typhus. A comparison of chloramphenicol and tetracycline in its treatment

Sheehy, Thomas W.

doi:10.1001/archinte.132.1.77

Cited by 45 publications

(43 citation statements)

References 10 publications

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“…The meta-analysis was performed for six antibiotics (doxycycline, chloramphenicol, azithromycin, rifampicin, roxithromycin, and tetracycline). The data comparing tetracycline versus chloramphenicol was extracted only from the study by Sheehy (14), and the contrast of teilithromycin versus doxycycline was only extracted from the study by Kim (15), so a metaanalysis was not performed for these comparisons. …”

Section: Characteristics Of Eligible Studiesmentioning

confidence: 99%

“…Chloramphenicol and tetracycline are contraindicated in pregnant women and children, and resistance to conventional antibiotics has been reported in some papers (13). Therefore, many new antibiotics, such as quinolones and macrolides, have also been used for the treatment of scrub typhus, especially in children and pregnant women (14)(15)(16). In the past few decades, many effec-tive antibiotics have been identified for the treatment of scrub typhus, but conflicting results have been reported for these studies.…”

Section: Introductionmentioning

confidence: 99%

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Meta-analysis of Drug Treatment for Scrub Typhus in Asia

Fang

Huang²,

Tu³

et al. 2012

Intern. Med.

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Objective Scrub typhus is an important febrile disease in Asia, and antibiotics have been used to treat this disease. The purpose of this study was to generate large-scale evidence of the efficacy of different antibiotic regimens for treating scrub typhus using a meta-analysis. Methods PubMed, Elsevier ScienceDirect, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), and Wanfang (Chinese) were searched to identify relevant articles. The data from eligible citations were extracted by two reviewers. All analyses were performed using the Cochrane Collaboration Review Manager 4.2 and Stata 10.0 software programs. Results We conducted a meta-analysis of 17 separate studies that evaluated the efficacy of treatment with the different antibiotic regimens for scrub typhus. The median time (h) to clearance of fever in the azithromycin-treated group was longer than that in the chloramphenicol-treated group (weighted mean difference [WMD] = 12.66, 95% confidence interval [CI]: 2.26,23.06). Adverse events were 2.95 (95%CI: 1.32, 6.61) times more likely to occur in the azithromycin-treated group than in the chloramphenicol-treated group. The clearance time (days) for the main symptoms (including fever, headache, rash and lymphadenectasis) in the doxycycline-treated group was shorter than that in the chloramphenicol-treated group (WMD = -0.4, 95%CI: -0.53, -0.26) in five trials. Adverse drug events occurred significantly less frequently in the azithromycin-treated group than in the doxycycline-treated group (relative risk [RR] = 0.47, 95%CI: 0.31,0.71). Conclusion Doxycycline was found to act more quickly, but more adverse drug events occur when using this regimen compared to azithromycin and chloramphenicol.

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Section: Characteristics Of Eligible Studiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Meta-analysis of Drug Treatment for Scrub Typhus in Asia

Fang

Huang²,

Tu³

et al. 2012

Intern. Med.

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“…Thrombocytopenia in scrub typhus is usually not accompanied with an elevated hematocrit which helps to differentiate it from dengue. Doxycycline has been considered as a drug of choice for treatment of scrub typhus [24]. The recommended duration of treatment is 7 days but it can be extended up to 15 days in complicated cases [5].…”

Section: Discussionmentioning

confidence: 99%

In Search of Scrub Typhus: A Prospective Analysis of Clinical and Epidemiological Profile of Patients from a Tertiary Care Hospital in New Delhi

Gupta¹,

Chaudhry²,

Kabra³

et al. 2015

AID

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Introduction: Scrub typhus is a febrile illness caused by Orientia tsutsugamushi which is transmitted by the larval stage of trombiculid mites. It has varied manifestations ranging from mild disease to fatal illness. The classical manifestations include fever, rash, lymphadenopathy and eschar. Serology is the preferred diagnostic tool with indirect immunofluorescence assay (IFA) as the current gold standard. Material & Methods: A total of 229 clinically suspected cases of Scrub typhus from 15 th of October 2013 to 15 th of October 2015 were enrolled in the study. Clinical, epidemiological and laboratory data of the patients were collected and analysed. The method for diagnosis was IgM immunofluorescence assay. Results: A total of 33 cases (14.4%) of scrub typhus were detected. Most of the cases (87%) presented in the months of September to November. Fever of >39˚C was seen in all 33 cases. Rash and eschar were seen in 24.2% and 18.2% cases, respectively. Lymphadenopathy (18.2%), hepatomegaly (48.5%), splenomegaly (21.2%) and icterus (15.2%) were seen in some cases. Pulmonary manifestations were noted in 69.7% of cases. Acute kidney injury (18.2%), encephalitis (21.2%), and myocarditis (15.15%) were the other complications observed. Common haematological abnormalities noted in patients of scrub typhus were anaemia (45.6%), leucocytosis (45.6%), thrombocytopenia (48.5%) and transaminitis (54.5%). 10 cases were treated by azithromycin while doxycycline was used for treatment in 28 cases. Conclusion: The nonspecific symptoms and lack of classical manifestations make the diagnosis of scrub typhus difficult. There is a definite need to increase awareness and heighten the suspicion, especially in the light of increasing number of patients presenting with atypical manifestations. N. Gupta et al.

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“…In addition, some patients develop an eschar at the site of the infected chigger bite, which is an important clinical clue for diagnosing scrub typhus, as 60-88 % of patients with scrub typhus exhibit an eschar. 1 Therefore, a methodical physical examination of the entire body should be performed to identify eschars in patients who come from an endemic area. …”

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confidence: 99%