Abstract:
Scrub typhus is a vector-borne disease caused by the pathogen Orientia
tsutsugamushi. We review the published literature for evidence on drug treatment
in scrub typhus. Doxycycline has a proven efficacy in several trials and a
meta-analysis, although resistance has been documented in parts of northern
Thailand. Macrolides are equally efficacious and have less adverse effects, but
they are expensive. Azithromycin is the recommended drug in pregnancy and for
children. Rifampicin is effective in areas where doxycycline resistance is
present. Quinolones have shown some degree of efficacy but the evidence is scant.
Most clinical evidence on drug treatment is from cases of mild-to-moderate scrub
typhus. Further study is needed on the efficacy of different antibiotics in the
treatment of severe, life-threatening scrub typhus.
