title: Doxycycline versus azithromycin for treatment of leptospirosis and scrub typhus.
abstract: Leptospirosis and scrub typhus are important causes of acute fever in Southeast Asia. Options for empirical therapy include doxycycline and azithromycin, but it is unclear whether their efficacies are equivalent. We conducted a multicenter, open, randomized controlled trial with adult patients presenting with acute fever (<15 days), without an obvious focus of infection, at four hospitals in Thailand between July 2003 and January 2005. Patients were randomly allocated to receive either a 7-day course of doxycycline or a 3-day course of azithromycin. The cure rate, fever clearance time, and adverse drug events were compared between the two study groups. A total of 296 patients were enrolled in the study. The cause of acute fever was determined for 151 patients (51%): 69 patients (23.3%) had leptospirosis; 57 patients (19.3%) had scrub typhus; 14 patients (4.7%) had murine typhus; and 11 patients (3.7%) had evidence of both leptospirosis and a rickettsial infection. The efficacy of azithromycin was not inferior to that of doxycycline for the treatment of both leptospirosis and scrub typhus, with comparable fever clearance times in the two treatment arms. Adverse events occurred more frequently in the doxycycline group than in the azithromycin group (27.6% and 10.6%, respectively; P = 0.02). In conclusion, doxycycline is an affordable and effective choice for the treatment of both leptospirosis and scrub typhus. Azithromycin was better tolerated than doxycycline but is more expensive and less readily available.
authors.affiliation: Udonthani Hospital, Udonthani Province, Thailand.
authors.forename: Kriangsak
authors.initials: K
authors.lastname: Phimda
authors.forename: Siriwan
authors.initials: S
authors.lastname: Hoontrakul
authors.forename: Chuanpit
authors.initials: C
authors.lastname: Suttinont
authors.forename: Sompong
authors.initials: S
authors.lastname: Chareonwat
authors.forename: Kitti
authors.initials: K
authors.lastname: Losuwanaluk
authors.forename: Sunee
authors.initials: S
authors.lastname: Chueasuwanchai
authors.forename: Wirongrong
authors.initials: W
authors.lastname: Chierakul
authors.forename: Duangjai
authors.initials: D
authors.lastname: Suwancharoen
authors.forename: Saowaluk
authors.initials: S
authors.lastname: Silpasakorn
authors.forename: Watcharee
authors.initials: W
authors.lastname: Saisongkorh
authors.forename: Sharon J
authors.initials: SJ
authors.lastname: Peacock
authors.forename: Nicholas P J
authors.initials: NP
authors.lastname: Day
authors.forename: Yupin
authors.initials: Y
authors.lastname: Suputtamongkol
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017963:Azithromycin / Q000627:therapeutic use*; D004318:Doxycycline / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007922:Leptospirosis / Q000188:drug therapy* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D018401:Sample Size; D012612:Scrub Typhus / Q000188:drug therapy* / Q000382:microbiology; D013785:Thailand; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D017963:Azithromycin; D004318:Doxycycline