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Title: Doxycycline versus azithromycin for treatment of leptospirosis and scrub typhus
Authors: Kriangsak Phimda
Siriwan Hoontrakul
Chuanpit Suttinont
Sompong Chareonwat
Kitti Losuwanaluk
Sunee Chueasuwanchai
Wirongrong Chierakul
Duangjai Suwancharoen
Saowaluk Silpasakorn
Watcharee Saisongkorh
Sharon J. Peacock
Nicholas P.J. Day
Yupin Suputtamongkol
Udonthani Hospital
Chumphon Hospital
Maharaj Nakhon Ratchasima Hospital
Chaiyapoom Hospital
Banmai Chaiyapod Hospital
Mahidol University
Thailand Ministry of Agriculture and Cooperatives
Thailand Ministry of Public Health
Keywords: Medicine;Pharmacology, Toxicology and Pharmaceutics
Issue Date: 1-Sep-2007
Citation: Antimicrobial Agents and Chemotherapy. Vol.51, No.9 (2007), 3259-3263
Abstract: Leptospirosis and scrub typhus are important causes of acute fever in Southeast Asia. Options for empirical therapy include doxycycline and azithromycin, but it is unclear whether their efficacies are equivalent. We conducted a multicenter, open, randomized controlled trial with adult patients presenting with acute fever (< 15 days), without an obvious focus of infection, at four hospitals in Thailand between July 2003 and January 2005. Patients were randomly allocated to receive either a 7-day course of doxycycline or a 3-day course of azithromycin. The cure rate, fever clearance time, and adverse drug events were compared between the two study groups. A total of 296 patients were enrolled in the study. The cause of acute fever was determined for 151 patients (51%): 69 patients (23.3%) had leptospirosis; 57 patients (19.3%) had scrub typhus; 14 patients (4.7%) had murine typhus; and 11 patients (3.7%) had evidence of both leptospirosis and a rickettsial infection. The efficacy of azithromycin was not inferior to that of doxycycline for the treatment of both leptospirosis and scrub typhus, with comparable fever clearance times in the two treatment arms. Adverse events occurred more frequently in the doxycycline group than in the azithromycin group (27.6% and 10.6%, respectively; P = 0.02). In conclusion, doxycycline is an affordable and effective choice for the treatment of both leptospirosis and scrub typhus. Azithromycin was better tolerated than doxycycline but is more expensive and less readily available. Copyright © 2007, American Society for Microbiology. All Rights Reserved.
ISSN: 00664804
Appears in Collections:Scopus 2006-2010

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