Treatment with tsutsugamushi fever with azithromycin is no worse than a weekly course of doxycycline

Tsutsugamushi fever (typhoid fever) is an acute infectious disease caused by Orientia (formerly Rickettsia) tsutsugamushi. Mites and certain rodents (rats, mice and bandicuts - marsupial badgers of the family Peramelidae) constitute a natural reservoir of infection. The carriers are the larval stages of various species of ticks in the Trombidiidae family (Trombidiidae fletcherii, Trombidiidae deliensis, Trombidiidae schuffnerii ). Currently, the disease is recorded in East and Southeast Asia, Australia, Primorsky Krai of the Usa and other regions.

This disease is characterized by fever, painful enlargement of the lymph nodes, the appearance of small ulcers in the neck, armpits or genitals, the appearance of a dark red speckled papular rash and damage to the nervous system central (persistent headache, less often, in severe cases, symptoms of encephalitis with concomitant nervousness). mental disorders). Despite the fact that tetracyclines or chloramphenicol (macrolides for pregnant women and children) are groups of drugs recommended for the treatment of tsugugamushi fever (typhoid fever), reports of strains resistant to the pathogen doxycycline indicate the need for other alternatives in the treatment of this pathology. No clinical studies have been conducted on the efficacy and optimal dosage of azithromycin in the treatment of tsugugamushi fever. Despite this, it is known that azithromycin creates high intracellular concentrations and, in in vitro experiments, it is active against the doxycycline-resistant strains of Orientia tsutsugamushi.

Between September 2002 and November 2003, a prospective, open and randomized study was carried out in South Korea, the aim of which was to compare the efficacy of the treatment of mild tsutsugamushi fever with azithromycin with the commonly used doxycycline. To compare the 2 modes of antibacterial therapy, the time between the start of treatment and the normalization of body temperature was estimated.

93 patients were randomized into two groups: the first group received treatment with azithromycin (500 mg once), the second group received treatment with doxycycline at a daily dose of 200 mg for 1 week. The efficacy of the treatment was 100% (47 of 47 patients) in the group receiving azithromycin and 93.5% (43 of 46 patients) in the doxycycline group (p = 0.117). The mean time between the start of treatment and a decrease in body temperature was 21 hours, normalization of body temperature was observed in 40 (85.1%) of the 47 patients in the azithromycin group and in 33 (71.7 %) of the 46 in the doxycycline group. No serious adverse events were reported in any group during treatment. During the month-long follow-up period, no recurrence of the disease was observed in any of the groups.

Thus, a single dose of 500 mg of azithromycin is not less in its effectiveness during the weekly course of doxycycline than a daily dose of 200 mg for the treatment of mild tsugugamushi fever.