Publication: Scrub Typhus and the Misconception of Doxycycline Resistance
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Issued Date
2020-05-23
Resource Type
ISSN
15376591
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2-s2.0-85085536838
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Mahidol University
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SCOPUS
Bibliographic Citation
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. Vol.70, No.11 (2020), 2444-2449
Suggested Citation
Tri Wangrangsimakul, Weerawat Phuklia, Paul N. Newton, Allen L. Richards, Nicholas P.J. Day Scrub Typhus and the Misconception of Doxycycline Resistance. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. Vol.70, No.11 (2020), 2444-2449. doi:10.1093/cid/ciz972 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/58153
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Title
Scrub Typhus and the Misconception of Doxycycline Resistance
Abstract
© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. Scrub typhus, a neglected infectious disease caused by the obligate intracellular bacterium Orientia tsutsugamushi, is a major cause of fever across the Asia Pacific region with more than a billion people at risk. Treatment with antibiotics such as doxycycline or chloramphenicol is effective for the majority of patients. In the 1990s, reports from northern Thailand raised a troubling observation; some scrub typhus patients responded poorly to doxycycline, which investigators attributed to doxycycline resistance. Despite the controversial nature of these reports, independent verification was neglected, with subsequent studies speculating on the role of doxycycline resistance in contributing to failure of treatment or prophylaxis. In this review, we have outlined the evidence for drug-resistant Orientia tsutsugamushi, assessed the evidence for doxycycline resistance, and highlight more recent findings unsupportive of doxycycline resistance. We conclude that doxycycline resistance is a misconception, with treatment outcome likely to be determined by other bacterial, host, and pharmacological factors.