Antibiotics for treating scrub typhus

Abstract

Background Scrub typhus, an important cause of acute fever in Asia, is caused by Orientia tsutsugamushi, an obligate intracellular bacterium. Antibiotics currently used to treat scrub typhus include tetracyclines, chloramphenicol, macrolides, and rifampicin. Objectives To assess and compare the effects of different antibiotic regimens for treatment of scrub typhus. Search methods We searched the following databases up to 8 January 2018: the Cochrane Infectious Diseases Group specialized trials register; CENTRAL, in the Cochrane Library (2018, Issue 1); MEDLINE; Embase; LILACS; and the metaRegister of Controlled Trials (mRCT). We checked references and contacted study authors for additional data. We applied no language or date restrictions. Selection criteria Randomized controlled trials (RCTs) or quasi-RCTs comparing antibiotic regimens in people with the diagnosis of scrub typhus based on clinical symptoms and compatible laboratory tests (excluding the Weil-Felix test). Data collection and analysis For this update, two review authors re-extracted all data and assessed the certainty of evidence. We meta-analysed data to calculate risk ratios (RRs) for dichotomous outcomes when appropriate, and elsewhere tabulated data to facilitate narrative analysis. Main results We included six RCTs and one quasi-RCT with 548 participants; they took place in the Asia-Pacific region: Korea (three trials), Malaysia (one trial), and Thailand (three trials). Only one trial included children younger than 15 years (N = 57). We judged five trials to be at high risk of performance and detection bias owing to inadequate blinding. Trials were heterogenous in terms of dosing of interventions and outcome measures. Across trials, treatment failure rates were low.

Scrub typhus complicated by acute respiratory distress syndrome and multiorgan failure; an unrecognized alarming entity in central India: A report of two cases

“…Other antibiotics useful for the treatment of scrub typhus are chloramphenicol, azithromycin, and rifampicin. [10] A patient of scrub typhus with acute respiratory distress, altered sensorium, seizures, or ARF should be immediately referred to a tertiary hospital for early necessary intervention and intensive supportive care. Metabolic acidosis, ARDS, altered sensorium, and shock were observed as independent predictors of mortality in a study done by Chrispal et al [11] Delay in diagnosis and treatment of scrub typhus result in increased mortality and morbidity.…”

Scrub typhus complicated by acute respiratory distress syndrome and multiorgan failure; an unrecognized alarming entity in central India: A report of two cases

“…Other antibiotics useful for the treatment of scrub typhus are chloramphenicol, azithromycin, and rifampicin. [10] A patient of scrub typhus with acute respiratory distress, altered sensorium, seizures, or ARF should be immediately referred to a tertiary hospital for early necessary intervention and intensive supportive care. Metabolic acidosis, ARDS, altered sensorium, and shock were observed as independent predictors of mortality in a study done by Chrispal et al [11] Delay in diagnosis and treatment of scrub typhus result in increased mortality and morbidity.…”

A review of the global epidemiology of scrub typhus

“…Antibiotics are usually able to abate patients’ fever rapidly, and this outcome is even used as a diagnostic indicator. Some randomized clinical trials determined that there is no significant difference in outcomes among tetracycline, doxycycline, telithromycin, and azithromycin, the latter of which is a recommended treatment considered to be as effective as doxycycline [ 215 , 216 , 217 ]. Rifampicin was shown to be more effective than tetracycline in patients responding poorly to doxycycline [ 6 , 217 , 218 ].…”

A CARE-compliant article: A case report of unusual eschar and extensive soft tissue necrosis in Tsutsugamushi disease

“…[20] Various complications can occur at the Chigger bite site, rarely with cellulitis. [22,23] In most cases, Tsutsugamushi disease can be treated conservatively. Most of its symptoms can be controlled with an oral antihistamine or topical corticosteroids.…”

“…[ 5 , 22 ] Complicated scrub typhus can be treated using doxycycline, azithromycin, chloramphenicol, tetracycline, macrolide, and rifampin. [ 16 , 23 ] However, without proper treatment, the mortality rate can go as high as 30%. [ 25 ] In our case, necrosis had progressed from the small eschar to extensive soft tissue necrosis.…”

Scrub typhus complicated by acute respiratory distress syndrome and multiorgan failure; an unrecognized alarming entity in central India: A report of two cases

“…Other antibiotics useful for the treatment of scrub typhus are chloramphenicol, azithromycin, and rifampicin. [10] A patient of scrub typhus with acute respiratory distress, altered sensorium, seizures, or ARF should be immediately referred to a tertiary hospital for early necessary intervention and intensive supportive care. Metabolic acidosis, ARDS, altered sensorium, and shock were observed as independent predictors of mortality in a study done by Chrispal et al [11] Delay in diagnosis and treatment of scrub typhus result in increased mortality and morbidity.…”

A review of the global epidemiology of scrub typhus

“…Antibiotics are usually able to abate patients’ fever rapidly, and this outcome is even used as a diagnostic indicator. Some randomized clinical trials determined that there is no significant difference in outcomes among tetracycline, doxycycline, telithromycin, and azithromycin, the latter of which is a recommended treatment considered to be as effective as doxycycline [ 215 , 216 , 217 ]. Rifampicin was shown to be more effective than tetracycline in patients responding poorly to doxycycline [ 6 , 217 , 218 ].…”

A CARE-compliant article: A case report of unusual eschar and extensive soft tissue necrosis in Tsutsugamushi disease

“…[20] Various complications can occur at the Chigger bite site, rarely with cellulitis. [22,23] In most cases, Tsutsugamushi disease can be treated conservatively. Most of its symptoms can be controlled with an oral antihistamine or topical corticosteroids.…”

“…[ 5 , 22 ] Complicated scrub typhus can be treated using doxycycline, azithromycin, chloramphenicol, tetracycline, macrolide, and rifampin. [ 16 , 23 ] However, without proper treatment, the mortality rate can go as high as 30%. [ 25 ] In our case, necrosis had progressed from the small eschar to extensive soft tissue necrosis.…”

Scrub typhus complicated by acute respiratory distress syndrome and multiorgan failure; an unrecognized alarming entity in central India: A report of two cases

“…Other antibiotics useful for the treatment of scrub typhus are chloramphenicol, azithromycin, and rifampicin. [10] A patient of scrub typhus with acute respiratory distress, altered sensorium, seizures, or ARF should be immediately referred to a tertiary hospital for early necessary intervention and intensive supportive care. Metabolic acidosis, ARDS, altered sensorium, and shock were observed as independent predictors of mortality in a study done by Chrispal et al [11] Delay in diagnosis and treatment of scrub typhus result in increased mortality and morbidity.…”

A review of the global epidemiology of scrub typhus

“…Antibiotics are usually able to abate patients’ fever rapidly, and this outcome is even used as a diagnostic indicator. Some randomized clinical trials determined that there is no significant difference in outcomes among tetracycline, doxycycline, telithromycin, and azithromycin, the latter of which is a recommended treatment considered to be as effective as doxycycline [ 215 , 216 , 217 ]. Rifampicin was shown to be more effective than tetracycline in patients responding poorly to doxycycline [ 6 , 217 , 218 ].…”

A CARE-compliant article: A case report of unusual eschar and extensive soft tissue necrosis in Tsutsugamushi disease

“…[20] Various complications can occur at the Chigger bite site, rarely with cellulitis. [22,23] In most cases, Tsutsugamushi disease can be treated conservatively. Most of its symptoms can be controlled with an oral antihistamine or topical corticosteroids.…”

“…[ 5 , 22 ] Complicated scrub typhus can be treated using doxycycline, azithromycin, chloramphenicol, tetracycline, macrolide, and rifampin. [ 16 , 23 ] However, without proper treatment, the mortality rate can go as high as 30%. [ 25 ] In our case, necrosis had progressed from the small eschar to extensive soft tissue necrosis.…”