Abstract | BACKGROUND: METHODS: Adult patients with strictly defined, mild scrub typhus were initially randomly assigned 1 week of daily oral treatment with 200 mg doxycycline (n=40), 600 mg rifampicin (n=38), or doxycycline with rifampicin (n=11). During the first year of treatment, the combined regimen was withdrawn because of lack of efficacy and the regimen was replaced with 900 mg rifampicin (n=37). Treatment outcome was assessed by fever clearance time (the time for oral temperature to fall below 37.3 degrees C). FINDINGS: About 12,800 fever patients were screened during the 3-year study to recruit 126 patients with confirmed scrub typhus and no other infection, of whom 86 completed therapy. Eight individuals received the combined regimen that was discontinued after 1 year. The median duration of pyrexia was significantly shorter (p=0.01) in the 24 patients treated with 900 mg daily rifampicin ( fever clearance time 22.5 h) and in the 26 patients who received 600 mg rifampicin ( fever clearance time 27.5 h) than in the 28 patients given doxycycline monotherapy ( fever clearance time 52 h). Fever resolved in a significantly higher proportion of patients within 48 h of starting rifampicin (900 mg=79% [19 of 24], 600 mg=77% [20 of 26]) than in patients treated with doxycycline (46% [13 of 28]; p=0.02). Severe gastrointestinal events warranted exclusion of two patients on doxycyline. There were two relapses after doxycycline therapy, but none after rifampicin therapy. INTERPRETATION:
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Authors | G Watt, P Kantipong, K Jongsakul, P Watcharapichat, D Phulsuksombati, D Strickman |
Journal | Lancet (London, England)
(Lancet)
Vol. 356
Issue 9235
Pg. 1057-61
(Sep 23 2000)
ISSN: 0140-6736 [Print] England |
PMID | 11009140
(Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S.)
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Chemical References |
- Anti-Bacterial Agents
- Doxycycline
- Rifampin
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Topics |
- Adolescent
- Adult
- Aged
- Anti-Bacterial Agents
(adverse effects, therapeutic use)
- Dose-Response Relationship, Drug
- Doxycycline
(adverse effects, therapeutic use)
- Eosinophilia
(chemically induced)
- Exanthema
(chemically induced)
- Female
- Fever
(drug therapy)
- Follow-Up Studies
- Gastrointestinal Diseases
(chemically induced)
- Humans
- Male
- Middle Aged
- Patient Dropouts
- Rifampin
(adverse effects, therapeutic use)
- Scrub Typhus
(drug therapy, pathology)
- Thailand
- Time Factors
- Treatment Outcome
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