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Prospective Study to Assess the Response to Therapy and Its Predictors in Children with Scrub Typhus.
J Trop Pediatr. 2021 10 06; 67(5)JT

Abstract

Doxycycline is the drug of choice for pediatric scrub typhus (ST) while azithromycin is considered as an equally effective alternative. This study was undertaken to assess the response to therapy and its predictors in pediatric ST cases treated with doxycycline and azithromycin. Children ≤12 year with fever ≥7 days were screened for ST by IgM ELISA (positive if optical density >0.5). All positive cases were divided into two groups based on whether treated with doxycycline or azithromycin. Fever clearance time (FCT), duration of hospitalization and other clinical characteristics of cases in both groups were compared. Out of 2710 children admitted with fever for more than 7 days, 660 cases (24.35%) tested positive for ST by IgM ELISA. Cases treated with azithromycin and doxycycline were 316 (47.87%) and 344 (52.12%), respectively. In our study, the FCT (p = 0.004), mean duration of hospital stay (p = 0.011), persistence of fever for >48 h after starting antibiotic therapy (p = 0.001) and severe ST requiring ICU admission (p = 0.046) were significantly lower in children who received doxycycline. The logistic regression analysis revealed that the presence of splenomegaly (Adjusted Odds Ratio (AOR) 2.60; 95% Confidence interval (CI) = 1.49-4.53; p = 0.001) and lung crepts (AOR 2.02; 95% CI = 1.06-3.85; p = 0.032) in azithromycin-treated group and presence of meningeal signs (AOR 16.11; 95% CI = 5.47-47.45; p < 0.001), anemia (AOR 2.28; 95% CI = 1.02-5.08; p = 0.044), lung crepts (AOR 2.66; 95% CI = 1.16-6.05; p = 0.020) and absence of eschar (AOR 3.48; 95% CI = 1.70-7.13; p = 0.001) in the doxycycline group was significantly associated with prolonged FCT (>48 h). Doxycycline is superior to azithromycin in defervescing fever, reducing hospital stay and preventing severity in pediatric ST.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Arun Babu T
Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Mangalagiri, Andhra Pradesh, India.
Narayanasamy DK
Department of Pediatrics, JIPMER, Karaikal, Pondicherry, India.
Jamir L
Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Guwahati, Assam, India.

MeSH

Anti-Bacterial AgentsAzithromycinChildDoxycyclineHumansProspective StudiesScrub Typhus

Pub Type(s)

Journal Article

Language

eng

PubMed ID

34613376

Citation

Arun Babu, Thirunavukkarasu, et al. "Prospective Study to Assess the Response to Therapy and Its Predictors in Children With Scrub Typhus." Journal of Tropical Pediatrics, vol. 67, no. 5, 2021.
Arun Babu T, Narayanasamy DK, Jamir L. Prospective Study to Assess the Response to Therapy and Its Predictors in Children with Scrub Typhus. J Trop Pediatr. 2021;67(5).
Arun Babu, T., Narayanasamy, D. K., & Jamir, L. (2021). Prospective Study to Assess the Response to Therapy and Its Predictors in Children with Scrub Typhus. Journal of Tropical Pediatrics, 67(5). https://doi.org/10.1093/tropej/fmab087
Arun Babu T, Narayanasamy DK, Jamir L. Prospective Study to Assess the Response to Therapy and Its Predictors in Children With Scrub Typhus. J Trop Pediatr. 2021 10 6;67(5) PubMed PMID: 34613376.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prospective Study to Assess the Response to Therapy and Its Predictors in Children with Scrub Typhus. AU - Arun Babu,Thirunavukkarasu, AU - Narayanasamy,Dinesh Kumar, AU - Jamir,Limalemla, PY - 2021/10/6/entrez PY - 2021/10/7/pubmed PY - 2021/11/3/medline KW - Azithromycin KW - children KW - doxycycline KW - fever clearance time KW - scrub typhus JF - Journal of tropical pediatrics JO - J Trop Pediatr VL - 67 IS - 5 N2 - Doxycycline is the drug of choice for pediatric scrub typhus (ST) while azithromycin is considered as an equally effective alternative. This study was undertaken to assess the response to therapy and its predictors in pediatric ST cases treated with doxycycline and azithromycin. Children ≤12 year with fever ≥7 days were screened for ST by IgM ELISA (positive if optical density >0.5). All positive cases were divided into two groups based on whether treated with doxycycline or azithromycin. Fever clearance time (FCT), duration of hospitalization and other clinical characteristics of cases in both groups were compared. Out of 2710 children admitted with fever for more than 7 days, 660 cases (24.35%) tested positive for ST by IgM ELISA. Cases treated with azithromycin and doxycycline were 316 (47.87%) and 344 (52.12%), respectively. In our study, the FCT (p = 0.004), mean duration of hospital stay (p = 0.011), persistence of fever for >48 h after starting antibiotic therapy (p = 0.001) and severe ST requiring ICU admission (p = 0.046) were significantly lower in children who received doxycycline. The logistic regression analysis revealed that the presence of splenomegaly (Adjusted Odds Ratio (AOR) 2.60; 95% Confidence interval (CI) = 1.49-4.53; p = 0.001) and lung crepts (AOR 2.02; 95% CI = 1.06-3.85; p = 0.032) in azithromycin-treated group and presence of meningeal signs (AOR 16.11; 95% CI = 5.47-47.45; p < 0.001), anemia (AOR 2.28; 95% CI = 1.02-5.08; p = 0.044), lung crepts (AOR 2.66; 95% CI = 1.16-6.05; p = 0.020) and absence of eschar (AOR 3.48; 95% CI = 1.70-7.13; p = 0.001) in the doxycycline group was significantly associated with prolonged FCT (>48 h). Doxycycline is superior to azithromycin in defervescing fever, reducing hospital stay and preventing severity in pediatric ST. SN - 1465-3664 UR - https://www.unboundmedicine.com/medline/citation/34613376/Prospective_Study_to_Assess_the_Response_to_Therapy_and_Its_Predictors_in_Children_with_Scrub_Typhus_ DB - PRIME DP - Unbound Medicine ER -