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Re-evaluating Presumptive Treatment with Doxycycline/ Azithromycin in Children With Acute Febrile Illness in a Scrub

Rohit Beniwal1, Neha Srivastava1, Aman Agarwal1

  • 1ICMR Regional Medical Research Centre, Gorakhpur, Uttar Pradesh, India.

Indian Pediatrics
|January 4, 2025
PubMed

Insights

In Gorakhpur, India, about 11.6% of children with acute febrile illness (AFI) had scrub typhus. This suggests revising presumptive antibiotic strategies to focus on laboratory-confirmed cases.

Area of Science:

  • Pediatric infectious diseases
  • Tropical medicine
  • Public health surveillance

Background:

  • Acute febrile illness (AFI) is common in children in Gorakhpur, Uttar Pradesh, India.
  • Orientia tsutsugamushi (Ots) is a potential cause of AFI, particularly during the peak acute encephalitis syndrome (AES) season.
  • Current strategies involve presumptive administration of doxycycline/azithromycin (PDA) for AFI.

Purpose of the Study:

  • To determine the proportion of children with AFI caused by Orientia tsutsugamushi (Ots) in Gorakhpur.
  • To re-evaluate the effectiveness of the presumptive administration of doxycycline/azithromycin (PDA) strategy for AFI.

Main Methods:

  • Children aged 2-18 years with AFI were enrolled from 16 peripheral health facilities in Gorakhpur.
  • Blood samples were analyzed for O. tsutsugamushi using serological and molecular methods.
  • Prescribed antibiotics were recorded for all enrolled patients.

Main Results:

  • Out of 345 children with AFI, 40 (11.6%) tested positive for scrub typhus.
  • Azithromycin was prescribed to 66.5% of patients, doxycycline to 5.5%, and both to 7.2%.
  • No AFI patients developed acute encephalitis syndrome.

Conclusions:

  • Approximately one in ten children with AFI in Gorakhpur were infected with Ots during the peak AES season.
  • The availability of scrub typhus testing allows for a potential shift from presumptive to laboratory-confirmed treatment.
  • Strengthening the existing hub-and-spoke model is recommended for managing Ots infections.
Abstract

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