title: Outcome of intravenous azithromycin therapy in patients with complicated scrub typhus compared with that of doxycycline therapy using propensity-matched analysis.
abstract: There are no well-matched, controlled studies comparing azithromycin with doxycycline for the treatment of complicated scrub typhus. A retrospective propensity score-matched case-control study was performed for patients who presented with complicated scrub typhus and were treated with doxycycline or azithromycin between 2001 and 2011. Data on comorbidities, clinical manifestations, laboratory studies, treatments, and outcomes were extracted for analysis. The clinical characteristics and outcomes of the azithromycin-treated group (n=73) were compared to those of the doxycycline-treated group (n=108). Of 181 patients, 73 from each group were matched by propensity scores. There were no significant differences in baseline characteristics between the matched groups. The treatment success and survival rates were not significantly different (89% [65/73 patients] versus 96% [70/73 patients] and 96% [70/73 patients] versus 96% [70/73 patients], respectively [P>0.05]). No difference was observed in the time to defervescence or length of hospital stay between the two groups (P>0.05). In complicated scrub typhus patients (n=181), multivariate analysis showed that only APACHE II score was an independent risk factor for mortality (95% confidence interval, 1.11 to 1.56; P<0.001). Our data suggest that outcomes of azithromycin therapy are comparable to those of doxycycline therapy in patients with complicated scrub typhus.
authors.affiliation: Department of Infectious Disease, Chonnam National University Medical School, Gwang-ju, Republic of Korea.
authors.forename: Mi-Ok
authors.initials: MO
authors.lastname: Jang
authors.forename: Hee-Chang
authors.initials: HC
authors.lastname: Jang
authors.forename: Uh Jin
authors.initials: UJ
authors.lastname: Kim
authors.forename: Joon Hwan
authors.initials: JH
authors.lastname: Ahn
authors.forename: Seung-Ji
authors.initials: SJ
authors.lastname: Kang
authors.forename: Sook-In
authors.initials: SI
authors.lastname: Jung
authors.forename: Hee-Young
authors.initials: HY
authors.lastname: Shin
authors.forename: Kyung-Hwa
authors.initials: KH
authors.lastname: Park
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017963:Azithromycin / Q000627:therapeutic use*; D016022:Case-Control Studies; D004318:Doxycycline / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D012612:Scrub Typhus / Q000188:drug therapy* / Q000401:mortality; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D017963:Azithromycin; D004318:Doxycycline