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Antibiotic Response to Pediatric Scrub Typhus in South India: Is Clinical Failure to Azithromycin to be Worried?
J Trop Pediatr. 2021 01 29; 67(1)JT

Abstract

BACKGROUND

Scrub typhus is typically associated with a rapid defervescence and clinical improvement within 48 h of initiation of appropriate antibiotics. But increasing reports of resistance to anti-rickettsial medications in scrub typhus are being reported in the literature.

METHODS

This is a retrospective observational study of children up to the age of 14 years admitted between July 2017 and March 2020, to a private medical college hospital in southern part of India. The aim of this study was to compare the clinical response to antibiotic therapy with doxycycline and azithromycin in pediatric scrub typhus infection.

RESULTS

One hundred thirty-eight children with scrub typhus infection were included for analysis. The median fever control time (h) was 12 (IQR = 6-29) and 24 (IQR = 10-52) with doxycycline and azithromycin respectively (p < 0.001*). Rapid fever control within 48 h was observed in 92% with doxycycline and in 74% with azithromycin (p < 0.001*). The clinical failure rate (defined by the necessity to change the antibiotics due to: (i) worsening of symptoms and signs of scrub typhus despite 48 h of antibiotics or (ii) persistence of fever and other symptoms of scrub typhus beyond 72 h), was significantly less with doxycycline (1%) compared with azithromycin (9.6%).

CONCLUSION

There has been a significant delayed clinical response to azithromycin in the treatment of scrub typhus in India, when compared to doxycycline. Hence it is preferable to use doxycycline as the first line of antibiotic for undifferentiated fever in scrub typhus endemic areas.

LAY SUMMARY

This retrospective study aims to compare the clinical response to doxycycline or azithromycin in the treatment of scrub typhus infection in children. The median fever control time, clinical failure rate and the proportion of children with rapid defervescence of fever within 48 h were significantly superior with doxycycline as compared to azithromycin. The findings of this study and those of similar studies in India represent a spectrum of delayed clinical response of Orientia tsutsugamushi to azithromycin as compared to doxycycline in this region.

Authors+Show Affiliations

Department of Pediatrics, MGMCRI, Puducherry 607402, India.Department of Pediatrics, MGMCRI, Puducherry 607402, India.Department of Pediatrics, MGMCRI, Puducherry 607402, India.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

33684931

Citation

Veerappan, Ilamaran, et al. "Antibiotic Response to Pediatric Scrub Typhus in South India: Is Clinical Failure to Azithromycin to Be Worried?" Journal of Tropical Pediatrics, vol. 67, no. 1, 2021.
Veerappan I, Ramar R, Palanisamy S. Antibiotic Response to Pediatric Scrub Typhus in South India: Is Clinical Failure to Azithromycin to be Worried? J Trop Pediatr. 2021;67(1).
Veerappan, I., Ramar, R., & Palanisamy, S. (2021). Antibiotic Response to Pediatric Scrub Typhus in South India: Is Clinical Failure to Azithromycin to be Worried? Journal of Tropical Pediatrics, 67(1). https://doi.org/10.1093/tropej/fmab013
Veerappan I, Ramar R, Palanisamy S. Antibiotic Response to Pediatric Scrub Typhus in South India: Is Clinical Failure to Azithromycin to Be Worried. J Trop Pediatr. 2021 01 29;67(1) PubMed PMID: 33684931.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Antibiotic Response to Pediatric Scrub Typhus in South India: Is Clinical Failure to Azithromycin to be Worried? AU - Veerappan,Ilamaran, AU - Ramar,Rathisharmila, AU - Palanisamy,Soundararajan, PY - 2021/3/8/entrez PY - 2021/3/9/pubmed PY - 2021/5/21/medline KW - azithromycin failure KW - doxycycline KW - rapid defervescence JF - Journal of tropical pediatrics JO - J Trop Pediatr VL - 67 IS - 1 N2 - BACKGROUND: Scrub typhus is typically associated with a rapid defervescence and clinical improvement within 48 h of initiation of appropriate antibiotics. But increasing reports of resistance to anti-rickettsial medications in scrub typhus are being reported in the literature. METHODS: This is a retrospective observational study of children up to the age of 14 years admitted between July 2017 and March 2020, to a private medical college hospital in southern part of India. The aim of this study was to compare the clinical response to antibiotic therapy with doxycycline and azithromycin in pediatric scrub typhus infection. RESULTS: One hundred thirty-eight children with scrub typhus infection were included for analysis. The median fever control time (h) was 12 (IQR = 6-29) and 24 (IQR = 10-52) with doxycycline and azithromycin respectively (p < 0.001*). Rapid fever control within 48 h was observed in 92% with doxycycline and in 74% with azithromycin (p < 0.001*). The clinical failure rate (defined by the necessity to change the antibiotics due to: (i) worsening of symptoms and signs of scrub typhus despite 48 h of antibiotics or (ii) persistence of fever and other symptoms of scrub typhus beyond 72 h), was significantly less with doxycycline (1%) compared with azithromycin (9.6%). CONCLUSION: There has been a significant delayed clinical response to azithromycin in the treatment of scrub typhus in India, when compared to doxycycline. Hence it is preferable to use doxycycline as the first line of antibiotic for undifferentiated fever in scrub typhus endemic areas. LAY SUMMARY: This retrospective study aims to compare the clinical response to doxycycline or azithromycin in the treatment of scrub typhus infection in children. The median fever control time, clinical failure rate and the proportion of children with rapid defervescence of fever within 48 h were significantly superior with doxycycline as compared to azithromycin. The findings of this study and those of similar studies in India represent a spectrum of delayed clinical response of Orientia tsutsugamushi to azithromycin as compared to doxycycline in this region. SN - 1465-3664 UR - https://www.unboundmedicine.com/medline/citation/33684931/Antibiotic_Response_to_Pediatric_Scrub_Typhus_in_South_India:_Is_Clinical_Failure_to_Azithromycin_to_be_Worried DB - PRIME DP - Unbound Medicine ER -