title: IAP Guidelines on Rickettsial Diseases in Children.
abstract: OBJECTIVE
  To formulate practice guidelines on rickettsial diseases in children for pediatricians across India.
  
  
  BACKGROUND
  Rickettsial diseases are increasingly being reported from various parts of India. Due to low index of suspicion, nonspecific clinical features in early course of disease, and absence of easily available, sensitive and specific diagnostic tests, these infections are difficult to diagnose. With timely diagnosis, therapy is easy, affordable and often successful. On the other hand, in endemic areas, where healthcare workers have high index of suspicion for these infections, there is rampant and irrational use of doxycycline as a therapeutic trial in patients of undifferentiated fevers. Thus, there is a need to formulate practice guidelines regarding rickettsial diseases in children in Indian context.
  
  
  METHODS
  A committee was formed for preparing guidelines on rickettsial diseases in children in June 2016. A meeting of consultative committee was held in IAP office, Mumbai and scientific content was discussed. Methodology and results were scrutinized by all members and consensus was reached. Textbook references and published guidelines were also used in few instances to make recommendations. Various Indian and international publications pertinent to present study were collated and guidelines were approved by all committee members. Future updates in these guidelines will be dictated by new scientific data in the field of rickettsial diseases in children.
  
  
  CONCLUSIONS
  Indian tick typhus and scrub typhus are commonly seen rickettsial diseases in India. It is recommended that practicing pediatricians should be well conversant with compatible clinical scenario, suggestive epidemiological features, differential diagnoses and suggestive laboratory features to make diagnosis and avoid over diagnosis of these infections, as suggested in these guidelines. Doxycycline is the drug of choice and treatment should begin promptly without waiting for confirmatory laboratory results.
authors.affiliation: Smile Healthcare, Rehabilitation and Research Foundation, Smile Institute of Child Health, Ramdaspeth, Akola; *Department of Pediatrics, Ashwini Medical College, Solapur; and #Dr Yewale Multispeciality Hospital for Children, Navi Mumbai; for Indian Academy of Pediatrics "Guidelines on Rickettsial Diseases in Children" Committee. Correspondence to: Dr Narendra Rathi, Consultant Pediatrician, Smile Healthcare, Rehabilitation and Research Foundation, Smile Institute of Child Health, Ramdaspeth, Akola, Maharashtra, India. drnbrathi@hotmail.com.
authors.forename: Narendra
authors.initials: N
authors.lastname: Rathi
authors.forename: Atul
authors.initials: A
authors.lastname: Kulkarni
authors.forename: Vijay
authors.initials: V
authors.lastname: Yewale
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D004318:Doxycycline / Q000627:therapeutic use; D006801:Humans; D007194:India; D010372:Pediatrics; D017410:Practice Guidelines as Topic; D012282:Rickettsia Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control
chemical_list: D000900:Anti-Bacterial Agents; D004318:Doxycycline