Antibiotic Response to Pediatric Scrub Typhus in South India: Is Clinical Failure to Azithromycin to be Worried?
Ilamaran Veerappan1, Rathisharmila Ramar1, Soundararajan Palanisamy1
1Department of Pediatrics, MGMCRI, Puducherry 607402, India.
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.
Insights
Doxycycline offers a faster and more effective treatment for pediatric scrub typhus than azithromycin in India. This study found doxycycline led to quicker fever control and lower treatment failure rates in children with scrub typhus.
Area of Science:
- Infectious Diseases
- Pediatrics
- Pharmacology
Background:
- Scrub typhus, a bacterial infection, typically responds quickly to antibiotics.
- Emerging reports indicate resistance to anti-rickettsial drugs in scrub typhus cases.
- Understanding optimal antibiotic treatment is crucial for managing this infection.
Purpose of the Study:
- To compare the clinical effectiveness of doxycycline versus azithromycin in treating pediatric scrub typhus.
- To evaluate key indicators such as fever control time and treatment failure rates.
- To provide evidence-based recommendations for scrub typhus management in children.
Main Methods:
- Retrospective observational study of 138 children under 14 years old admitted between July 2017 and March 2020.
- Comparison of clinical response to doxycycline and azithromycin for scrub typhus.
- Analysis of fever control time, rapid defervescence, and clinical failure rates.
Main Results:
- Doxycycline showed a significantly shorter median fever control time (12 hours) compared to azithromycin (24 hours).
- Rapid fever control within 48 hours was achieved in 92% of children on doxycycline versus 74% on azithromycin.
- The clinical failure rate was substantially lower with doxycycline (1%) than with azithromycin (9.6%).
Conclusions:
- Doxycycline demonstrates superior efficacy over azithromycin for treating pediatric scrub typhus in India.
- A delayed clinical response to azithromycin was observed in this region.
- Doxycycline is recommended as the preferred first-line antibiotic for undifferentiated fever in scrub typhus-endemic areas.
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