Antibiotics for treating scrub typhus

Abstract

Background Scrub typhus is a bacterial disease in regions of Asia and the Pacific. Antibiotics (chloramphenicol, tetracycline, and doxycycline) have been used to treat the disease. Resistance to these antibiotics has been reported. Objectives To evaluate antibiotic regimens for treating scrub typhus. Search strategy We searched the Cochrane Infectious Diseases Group specialized trials register (January 2010); CENTRAL (The Cochrane Library, Issue 4, 2009); MEDLINE (1966 to January 2010); EMBASE (1980 to January 2010); LILACS (1982 to January 2010); mRCT (January 2010). We checked references and contacted authors for additional data. Selection criteria Randomized and quasi-randomized studies comparing antibiotic regimens in people diagnosed with scrub typhus. Data collection and analysis Both authors screened the search results, assessed eligibility, quality and extracted data. We used Review Manager (Version 5.0.2), and expressed results as Relative Risk (binary) or weighted mean difference (continuous), with 95% confidence intervals. Main results Seven small trials met the inclusion criteria. In one trial, no difference was detected between tetracycline and chloramphenicol in relation to fever at 48 hours (1 patient febrile in each arm; N=60). No difference was detected in two trials that compared doxycycline and tetracycline. Rifampicin was more effective than doxycycline in one trial (participants febrile at 48 hours, RR 0.41, 95% CI 0.22 to 0.77). No difference was detected in two trials evaluated azithromycin against doxycycline, with no difference in fever at 48 hours (RR 1.22, 95% CI 0.17 to 8.92; 150 participants). One trial compared telithromycin with doxycycline, and the effects were similar. No trials reported death or serious complications. Authors' conclusions Data are limited because trials are small. There are no obvious differences between tetracycline, doxycycline, telithromycin,or azithromycin; rifampicin may be better than tetracycline in areas where scrub typhus appears to respond poorly to standard anti-rickettsial drugs. Plain language summary Scrub typhus is transmitted by chiggers (mites), is a bacterial infection and causes fever and a typical sore on the skin, and is common in the western Pacific region and many parts of Asia, particularly in agricultural workers and travellers in areas where the disease is common, particularly people camping, rafting, or trekking . This review summarizes the information from seven small trials about the effects of antibiotics on scrub typhus. Most of the antibiotics tested worked: this includes: doxycycline, tetracycline, telithromycin and azithromycin. Rifampicin seem to be more effective than doxycycline in areas where scrub typhus appears to respond poorly to standard anti-rickettsial drugs. Assessed as up-to-date: 25 MAY 2010