Antibiotics for treating scrub typhus

Abstract

Background: Scrub typhus is a cause of fever in regions of Asia and the Pacific. Recently, resistance to antibiotics has been reported.

Objectives: To assess treatment regimens for scrub typhus through time to fever resolution and incidence of relapse.

Search strategy: Cochrane Controlled Trials Register, MEDLINE, EMBASE, and contacted individual researchers for unpublished data.

Selection criteria: Randomised and pseudorandomised studies; patients diagnosed with scrub typhus defined by authors; any comparison of antibiotic regimens for treating scrub typhus.

Data collection and analysis: Trial quality was assessed, and data abstracted by both reviewers.

Main results: Three trials met the inclusion criteria. One small trial compared tetracycline against chloramphenicol. The other two trials compared doxycycline with tetracycline, and showed little difference in the proportion febrile at 48 hours, with no relapses after either drug.

Reviewer's conclusions: Tetracycline and doxycycline seem to be effective in treating scrub typhus. Further research is required to identify appropriate treatment in areas where Orientia tsutsugamushi resistant to doxycycline has been reported.