Which medications are used in the treatment of scrub typhus?

Updated: Apr 19, 2018
  • Author: David J Cennimo, MD, FAAP, FACP, FIDSA, AAHIVS; Chief Editor: Russell W Steele, MD  more...
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To reduce morbidity and mortality, treatment of scrub typhus must be initiated early in the course of the disease, on the basis of a presumptive diagnosis. Patients respond more promptly than in rickettsial infections, with resolution of fever expected within 24-36 hours.

The treatment of choice is tetracycline or doxycycline. [61] (O tsutsugamushi strains with reduced susceptibility to doxycycline have been identified, especially in northern Thailand. [8, 5, 62] ) A 7-day antibiotic regimen is usually effective. [4] Relapse may occur and necessitate administration of additional courses of antibiotics. [38]

Newer macrolides may be appropriate for children and pregnant women. [8, 38] In a small trial, azithromycin was shown to have efficacy comparable to that of doxycycline. [48] Rifampin and azithromycin have been used successfully in areas where scrub typhus is resistant to conventional therapy. [5, 8, 63]

In another small trial, roxithromycin was as effective as doxycycline and chloramphenicol for the treatment of scrub typhus [64] ; however, a subsequent study found it to be ineffective. [34] In a prospective, open-label, randomized trial of Korean patients with mild-to-moderate scrub typhus, the efficacy and safety of a 5-day telithromycin regimen compared favorably with those of a 5-day doxycycline regimen. [65]

Studies of fluoroquinolones have yielded mixed results, and their use cannot be advocated at this time. [61, 66, 67]

Consultation with an infectious diseases specialist should be considered if the patient does not improve on antibiotics or has atypical symptoms. The persistence of viable O tsutsugamushi was evaluated in patients who had recovered from scrub typhus. [68] O tsutsugamushi may cause a chronic latent symptomatic infection in spite of what is now considered adequate antibiotic therapy.

Further studies are needed to improve antibiotic treatment of severe and resistant scrub typhus, as well as to improve treatment in children and pregnant women.

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