A third of patients develop severe disease that affects many organs of the body and causes fatal low blood pressure. Mortality rates in severe disease can reach 70 percent without treatment and 24 percent with treatment.

In a study of 800 adult patients, a team of researchers including the Christian Medical College, Vellore, Tamil Nadu, and PGIMER Chandigarh showed that treatment with intravenous doxycycline and azithromycin was more effective than using either drug alone.

Scrub Typhus: Treatment

Published findings New England Journal of Medicine, showed that antibiotic combination therapy led to early – on the seventh day – discharge of patients from the hospital. Patients also had less frequent complications such as respiratory distress syndrome (ARDS), hepatitis, hypotension/shock, meningoencephalitis, and renal failure. The overall mortality rate in this study was 12 percent.


Prof George M Varghese from CMC’s Department of Infectious Diseases said, “This new evidence will change treatment and save thousands of lives with typhoid in the future.”

Scrub typhus is a major public health threat in India and other South Asian countries. In endemic areas, it is estimated that approximately one billion people are at risk of infection, one million are infected, and 1.5 million die each year.

Since Orientia tsutsugamushi is a bacterium that reproduces and survives inside host cells, it is important that the antibiotic reaches high concentrations in the host cells as well.

This study found that when both azithromycin and doxycycline were given together to patients with severe scrub typhus, the bacteria cleared more quickly and the patients recovered more quickly.

This may be because doxycycline and azithromycin stop the bacteria from producing the protein through different but complementary mechanisms.

The combination of two drugs can lead to a more complete blockade of protein synthesis and, as a result, a decrease in bacterial growth and reproduction.

Because the combination therapy quickly controlled bacterial growth in the first week of infection, severe disease may have been prevented and symptom resolution accelerated, the researchers said.

Source: IANS

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