title: Meta-analysis of drug treatment for scrub typhus in Asia.
abstract: OBJECTIVE
  Scrub typhus is an important febrile disease in Asia, and antibiotics have been used to treat this disease. The purpose of this study was to generate large-scale evidence of the efficacy of different antibiotic regimens for treating scrub typhus using a meta-analysis.
  
  
  METHODS
  PubMed, Elsevier ScienceDirect, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), and Wanfang (Chinese) were searched to identify relevant articles. The data from eligible citations were extracted by two reviewers. All analyses were performed using the Cochrane Collaboration Review Manager 4.2 and Stata 10.0 software programs.
  
  
  RESULTS
  We conducted a meta-analysis of 17 separate studies that evaluated the efficacy of treatment with the different antibiotic regimens for scrub typhus. The median time (h) to clearance of fever in the azithromycin-treated group was longer than that in the chloramphenicol-treated group (weighted mean difference [WMD] = 12.66, 95% confidence interval [CI]: 2.26,23.06). Adverse events were 2.95 (95%CI: 1.32, 6.61) times more likely to occur in the azithromycin-treated group than in the chloramphenicol-treated group. The clearance time (days) for the main symptoms (including fever, headache, rash and lymphadenectasis) in the doxycycline-treated group was shorter than that in the chloramphenicol-treated group (WMD = -0.4, 95%CI: -0.53, -0.26) in five trials. Adverse drug events occurred significantly less frequently in the azithromycin-treated group than in the doxycycline-treated group (relative risk [RR] = 0.47, 95%CI: 0.31,0.71).
  
  
  CONCLUSIONS
  Doxycycline was found to act more quickly, but more adverse drug events occur when using this regimen compared to azithromycin and chloramphenicol.
authors.affiliation: School of Public Health, Anhui Medical University, China.
authors.forename: Yirong
authors.initials: Y
authors.lastname: Fang
authors.forename: Zhaohui
authors.initials: Z
authors.lastname: Huang
authors.forename: Chunyu
authors.initials: C
authors.lastname: Tu
authors.forename: Lijie
authors.initials: L
authors.lastname: Zhang
authors.forename: Dongqing
authors.initials: D
authors.lastname: Ye
authors.forename: Bao-Ping
authors.initials: BP
authors.lastname: Zhu
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D001208:Asia / Q000453:epidemiology; D017963:Azithromycin / Q000009:adverse effects / Q000627:therapeutic use; D002701:Chloramphenicol / Q000009:adverse effects / Q000627:therapeutic use; D004318:Doxycycline / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012612:Scrub Typhus / Q000188:drug therapy* / Q000453:epidemiology*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D002701:Chloramphenicol; D017963:Azithromycin; D004318:Doxycycline