title: Levofloxacin versus tetracycline antibiotics for the treatment of scrub typhus.
abstract: BACKGROUND
  Scrub typhus is an important febrile disease in Southeast Asia and is caused by Orientia tsutsugamushi. Fluoroquinolones have proved to be effective for scrub typhus in an animal model. However, it is unclear whether they are also effective clinically.
  
  
  METHODS
  We retrospectively reviewed the hospital-based medical records of patients diagnosed to have scrub typhus by an indirect immunofluorescence antibody assay or PCR at a large referral hospital in Taiwan for a 6-year period (2001-2007). To determine the efficacy of levofloxacin for the treatment of scrub typhus, we divided the patients into a levofloxacin-treated group and a tetracycline antibiotics-treated group.
  
  
  RESULTS
  Out of 132 patients with scrub typhus, 71 initially received levofloxacin and 61 initially received tetracycline antibiotics. There was no statistically significant difference in the effective rate between the two groups (91.5% and 95.1% cured, respectively; p=0.648). The time to defervescence in the levofloxacin-treated group was longer than in the other group (49+/-41.1 and 24+/-19.6hours, respectively; p=0.001). In the patients with higher APACHE II scores, higher mortality was found in the levofloxacin-treated group (44.4% and 0%; p=0.033).
  
  
  CONCLUSIONS
  Levofloxacin is effective in patients with scrub typhus, but has a longer time to defervescence compared with tetracycline antibiotics. When levofloxacin is used for severe scrub typhus, higher mortality may be attributed to the longer time to defervescence.
authors.affiliation: Section of Infectious Disease, Department of Medicine, Buddhist Dalin Tzu Chi General Hospital, No. 2, Minsheng Rd, Dalin Township, Chiayi 62247, Taiwan. antibody_1@msn.com
authors.forename: Chen-Chi
authors.initials: CC
authors.lastname: Tsai
authors.forename: Chorng-Jang
authors.initials: CJ
authors.lastname: Lay
authors.forename: Chun-Lung
authors.initials: CL
authors.lastname: Wang
authors.forename: Yu-Huai
authors.initials: YH
authors.lastname: Ho
authors.forename: Lih-Shinn
authors.initials: LS
authors.lastname: Wang
authors.forename: Li-Kuang
authors.initials: LK
authors.lastname: Chen
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D064704:Levofloxacin; D008297:Male; D008875:Middle Aged; D015242:Ofloxacin / Q000627:therapeutic use*; D012189:Retrospective Studies; D012612:Scrub Typhus / Q000188:drug therapy*; D013624:Taiwan; D013752:Tetracycline / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D064704:Levofloxacin; D015242:Ofloxacin; D013752:Tetracycline