Scrub typhus medical therapy: Difference between revisions
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Revision as of 15:36, 3 December 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Medical Therapy
Without treatment, the disease is often fatal. Since the use of antibiotics, case fatalities have decreased from 4%–40% to less than 2%.
The drug most commonly used is doxycycline; but chloramphenicol is an alternative. Strains that are resistant to doxycycline and to chloramphenicol are common in northern Thailand.[1][2] Rifampin and azithromycin[3] are alternatives.[4] Azithromycin is an alternative in children[5] and pregnant women with scrub typhus,[6][7][8] and when doxycycline-resistance is suspected.[9] Ciprofloxacin cannot be used safely in pregnancy and is associated with stillbirths and miscarriage.[8][10] Combination therapy with doxycycline and rifampicin is not recommended due to possible antagonism.[11]
Other drugs that may be effective are clarithromycin, roxithromycin, and the fluoroquinolones, but there is no clinical evidence on which to recommend their use. Azithromycin or chloramphenicol is useful for infection in children or pregnant women.
References
- ↑ Watt G; Chouriyagune C; Ruangweerayud R; et al. (1996). "Scrub typhus infections poorly responsive to antibiotics in northern Thailand". Lancet. 348 (9020): 86–89. doi:10.1016/S0140-6736(96)02501-9. PMID 8676722. Unknown parameter
|author-separator=ignored (help) - ↑ Kollars TM; Bodhidatta D; Phulsuksombati D; et al. (2003). "Short report: variation in the 56-kD type-specific antigen gene of Orientia tsutsugamushi isolated from patients in Thailand". Am J Trop Med Hyg. 68 (3): 299–300. PMID 12685633. Unknown parameter
|author-separator=ignored (help) - ↑ Phimda K; Hoontrakul S; Suttinont C; et al. (2007). "Doxycycline versus Azithromycin for Treatment of Leptospirosis and Scrub Typhus". Antimicrob Agents Chemother. 51 (9): 3259–63. doi:10.1128/AAC.00508-07. PMC 2043199. PMID 17638700. Unknown parameter
|author-separator=ignored (help) - ↑ Panpanich R, Garner P (2009). Panpanich, Ratana, ed. "Antibiotics for treating scrub typhus". Cochrane Database Syst Rev (1): CD002150. doi:10.1002/14651858.CD002150. PMID 10796680.
- ↑ Mahajan SK, Rolain J-M, Sankhyan N, Kaushal RK, Raoult D (2008). "Pediatric scrub typhus in Indian Himalayas". Indian Journal of Pediatrics. 75 (9): 947–9. doi:10.1007/s12098-008-0186-3. PMID 18810342.
- ↑ Watt, G; Kantipong, P; Jongsakul, K; Watcharapichat, P; Phulsuksombati, D (1999). "Azithromycin Activities against Orientia tsutsugamushi Strains Isolated in Cases of Scrub Typhus in Northern Thailand". Antimicrob Agents Chemother. 43 (11): 2817–2818. PMC 89570. PMID 10543774.
- ↑ Choi EK, Pai H (1998). "Azithromycin therapy for scrub typhus during pregnancy". Clin Infect Dis. 27 (6): 1538–9. doi:10.1086/517742. PMID 9868680.
- ↑ 8.0 8.1 Kim YS, Lee HJ, Chang M, Son SK, Rhee YE, Shim SK (2006). "Scrub typhus during pregnancy and its treatment: a case series and review of the literature". Am J Trop Med Hyg. 75 (5): 955–9. PMID 17123995.
- ↑ <Please add first missing authors to populate metadata.> (2003). "Efficacy of azithromycin for treatment of mild scrub-typhus infections in South Korea". Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 43: abstract no. L–182.
- ↑ Mathai E, Rolain JM, Verghese L, Mathai M, Jasper P, Verghese G, Raoult D (2003). "Case reports: scrub typhus during pregnancy in India". Trans R Soc Trop Med Hyg. 97 (5): 570–2. doi:10.1016/S0035-9203(03)80032-9. PMID 15307429.
- ↑ Watt G; Kantipong P; Jongsakul K; et al. (2000). "Doxycycline and rifampicin for mild scrub-typhus infections in northern Thailand: a randomised trial". Lancet. 356 (9235): 1057–1061. doi:10.1016/S0140-6736(00)02728-8. PMID 11009140. Unknown parameter
|author-separator=ignored (help)