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Antibiotics for treating scrub typhus.

Iman El Sayed1, Qin Liu, Ian Wee

  • 1Department of Biomedical Informatics and Medical Statistics, Medical Research Institute, Alexandria University, Alexandria, Egypt.

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This review found that doxycycline, tetracycline, azithromycin, and rifampicin are effective treatments for scrub typhus, with few treatment failures. However, evidence quality is low, and rifampicin should not be a first-line option due to tuberculosis risks.

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Area of Science:

  • Infectious Diseases
  • Bacteriology
  • Clinical Pharmacology

Background:

  • Scrub typhus, caused by Orientia tsutsugamushi, is a significant cause of acute fever in Asia.
  • Current treatments include tetracyclines, chloramphenicol, macrolides, and rifampicin.

Purpose of the Study:

  • To compare the efficacy of various antibiotic regimens for treating scrub typhus.
  • To assess treatment outcomes and adverse events associated with different antibiotic choices.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials (RCTs) and quasi-RCTs.
  • Searched multiple databases up to January 2018, with no language or date restrictions.
  • Included six RCTs and one quasi-RCT involving 548 participants, primarily from the Asia-Pacific region.

Main Results:

  • Treatment failure rates were generally low across included trials.
  • Doxycycline and tetracycline showed uncertain differences in treatment failure and fever resolution.
  • Doxycycline and macrolides demonstrated low-certainty evidence for similar efficacy in fever resolution.
  • Evidence comparing doxycycline with rifampicin was very low certainty; rifampicin is not recommended as a first-line treatment.

Conclusions:

  • Doxycycline, tetracycline, azithromycin, and rifampicin are effective for scrub typhus, but evidence quality is mostly low to very low.
  • Rifampicin should be considered a second-line option only after excluding active tuberculosis.
  • Further high-quality research is needed to compare doxycycline with macrolides and evaluate other antibiotics and severe scrub typhus treatments.