Antibiotics for treating scrub typhus

What is the aim of this review?

The aim of this Cochrane Review is to find out whether certain antibiotics are more effective in treating scrub typhus. We collected and analysed all relevant studies to answer this question and included seven studies.

Key messages

Tetracycline, doxycycline, azithromycin, and rifampicin are effective antibiotics for scrub typhus treatment that have led to few treatment failures. For specific outcomes, some low‐certainty evidence suggests there may be little or no difference between tetracycline, doxycycline, and azithromycin. Healthcare workers should not use rifampicin as a first‐line treatment. Researchers should standardize the way they diagnose and assess scrub typhus.

What was studied in the review?

Scrub typhus is an important cause of fever in Asia. We studied people with scrub typhus diagnosed by health professionals and confirmed by laboratory tests. We compared different antibiotic treatments. We looked at whether the choice of antibiotic made a difference in the number of people who experienced failed treatment, and we determined the proportions who had resolution of fever at 48 hours.

What are the main results of the review?

We found seven relevant studies. Only one study included children younger than 15 years.

We are uncertain whether doxycycline compared to tetracycline affects treatment failure, as the certainty of the evidence is very low. Studies looked at a resolution of fever within five days. Doxycycline compared to tetracycline may make little or no difference in the proportion of patients with resolution of fever within 48 hours and in time to defervescence. Studies did not formally report serious adverse events.

We are uncertain whether macrolides compared to doxycycline affect treatment failure, resolution of fever within five days, time to defervescence, or serious adverse events, as the certainty of the evidence is very low. Macrolides compared to doxycycline may make little or no difference in the proportion of patients with resolution of fever within five days.

We are uncertain whether rifampicin compared to doxycycline affects treatment failure, the proportion of patients with resolution of fever within 48 hours, or time to defervescence, as the certainty of evidence, is very low. The single study that performed this comparison did not look at resolution of fever within five days and did not formally report serious adverse events.

How up‐to‐date is this review?

We searched for studies that had been published up to 8 January 2018.