A Prospective, Open-label, Randomized Trial of Doxycycline Versus Azithromycin for the Treatment of Uncomplicated Murine Typhus

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
Paul N NewtonRattanaphone Phetsouvanh

Abstract

Murine typhus, or infection with Rickettsia typhi, is a global but neglected disease without randomized clinical trials to guide antibiotic therapy. A prospective, open, randomized trial was conducted in nonpregnant, consenting inpatient adults with rapid diagnostic test evidence of uncomplicated murine typhus at 2 hospitals in Vientiane, Laos. Patients were randomized to 7 days (D7) or 3 days (D3) of oral doxycycline or 3 days of oral azithromycin (A3). Primary outcome measures were fever clearance time and frequencies of treatment failure and relapse. Between 2004 and 2009, the study enrolled 216 patients (72 per arm); 158 (73.2%) had serology/polymerase chain reaction (PCR)-confirmed murine typhus, and 52 (24.1%) were R. typhi PCR positive. The risk of treatment failure was greater for regimen A3 (22.5%; 16 of 71 patients) than for D3 (4.2%; 3 of 71) or D7 (1.4%; 1 of 71) (P < .001). Among R. typhi PCR-positive patients, the area under the time-temperature curve and the fever clearance time were significantly higher for A3 than for D3 (1.8- and 1.9-fold higher, respectively; P = .005) and D7 (1.5- and 1.6-fold higher; P = .02). No patients returned with PCR-confirmed R. typhi relapse. In Lao adults, azithromycin is inferior ...Continue Reading

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Citations

Dec 11, 2019·The American Journal of Tropical Medicine and Hygiene·Ivo ElliottRory Bowden
Apr 11, 2020·The American Journal of Tropical Medicine and Hygiene·Sandhya DhawanStuart D Blacksell
Sep 15, 2020·PLoS Neglected Tropical Diseases·Johannes F Doppler, Paul N Newton
Sep 19, 2020·Therapeutic Advances in Infectious Disease·Brendan O'Kelly, John S Lambert
Aug 23, 2019·The American Journal of Tropical Medicine and Hygiene·Teresa A ChuengChristopher L Dayton
Oct 8, 2019·Epidemiology and Infection·Matthew T RobinsonStuart D Blacksell
Jun 18, 2020·Case Reports in Obstetrics and Gynecology·Irene A StaffordKenneth Muldrew
Sep 30, 2020·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Abhishek GiriBuddha Basnyat
Nov 6, 2020·BMJ Case Reports·Hemesh Mahesh Patel
Feb 13, 2021·Research and Reports in Tropical Medicine·Maria A Caravedo MartinezLucas S Blanton
Mar 7, 2021·Pathogens·Melinda B TanabeCamille M Webb

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Methods Mentioned

BETA
pregnancy test
PCR

Clinical Trials Mentioned

ISRCTN47812566

Software Mentioned

Stata

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