Antibiotics for treating scrub typhus.
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.


OBJECTIVE
To evaluate antibiotic regimens for treating scrub typhus.


METHODS
We searched the Cochrane Infectious Diseases Group specialized trials register (March 2002); the Cochrane Controlled Trials Register (The Cochrane Library, Issue 1, 2002); MEDLINE (1966 to March 2002); EMBASE (1988 to January 2002); LILACS (2001, 40a Edition CD-ROM). We checked references and contacted authors for additional data.


METHODS
Randomized and quasi-randomized studies comparing antibiotic regimens in people diagnosed with scrub typhus.


METHODS
One reviewer screened the search results; both reviewers assessed eligibility, quality and extracted data. We used Review Manager (Version 4.1), and expressed results as Relative Risk (binary) or weighted mean difference (continuous), with 95% confidence intervals.


RESULTS
Four trials involving 451 adults met the inclusion criteria. One small study did not demonstrate a difference between tetracycline with chloramphenicol (participants afebrile after 48 hours, Relative Risk 1.00; 95% confidence interval 0.07 to 15.26). Two small trials did not show a difference between doxycycline and tetracycline (participants afebrile after 48 hours, Relative Risk 0.46; 95% confidence interval 0.12 to 1.75). One trial showed rifampicin to be more effective than doxycycline (for eliminating fever, Relative Risk 0.41; 95% confidence interval 0.22 to 0.77; no relapses in either group).


CONCLUSIONS
Limited data has not demonstrated a difference between tetracycline and doxycycline. Limited data suggest rifampicin is effective in areas where scrub typhus appears to respond poorly to standard anti-rickettsial drugs.
Panpanich
R
R
Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. rpanpani@med.cmu.ac.th
Garner
P
P
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012612:Scrub Typhus / Q000188:drug therapy*
D000900:Anti-Bacterial Agents