eMedicine Specialties > Infectious Diseases > Bacterial Infections

Typhus: Treatment & Medication

Author: Jason F Okulicz, MD, Assistant Professor of Medicine, Uniformed Services University of the Health Sciences; Staff, Infectious Disease Service, Brooke Army Medical Center
Coauthor(s): Mark S Rasnake, MD, Assistant Professor of Medicine, Program Director, Internal Medicine Residency, University of Tennessee Graduate School of Medicine; Consulting Staff, Department of Infectious Diseases, University of Tennessee Medical Center at Knoxville; Eric A Hansen, DO, Fellow, Clinical Instructor, Department of Internal Medicine, Division of Infectious Diseases, Winthrop-University Hospital, State University of New York at Stony Brook; Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Contributor Information and Disclosures

Updated: Sep 18, 2008

Treatment

Medical Care

  • Antibiotics are the standard of care in the treatment of typhus.
    • Continue antibiotics for 48-72 hours after the fever has resolved.
    • A second course of antibiotic therapy is usually curative in cases of recrudescent typhus,.
  • Other supportive measures may be used as necessary.

Activity

Activity is as tolerated.

Medication

The goals of pharmacotherapy are to reduce morbidity, to prevent complications, and to eradicate infection.

Antibiotics

Specific antimicrobial therapy effective against rickettsia should be used. Doxycycline and chloramphenicol are used as antirickettsial agents for the treatment of typhus.

In Thailand, the emergence of doxycycline-resistant scrub typhus has caused clinicians to seek alternative antimicrobials.6 Azithromycin and rifampicin have been shown to be effective in small trials conducted in areas with known doxycycline resistance.7


Doxycycline (Doryx, Bio-Tab, Vibramycin)

Inhibits protein synthesis and thus bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria. No dose adjustment is necessary in renal impairment.

Adult

200 mg PO/IV bid for 3 d, then maintenance dose 100 mg PO/IV bid

Pediatric

<8 years: Not recommended
>8 years: Administer as in adults

Absorption may be minimally impaired by aluminum-, magnesium-, and calcium-containing antacids and by iron-containing compounds and bismuth subsalicylate; oral contraceptives may be less effective when doxycycline is concomitantly administered; half-life may be reduced by barbiturates, phenytoin, and carbamazepine; may rarely increase hypoprothrombinemic effects of anticoagulants

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

May result in benign intracranial hypertension in adults with prolonged use; doxycycline is rarely, if ever, associated with phototoxic reactions; use during tooth development (last half of pregnancy through 8 y) can cause permanent discoloration of teeth


Chloramphenicol (Chloromycetin)

Generally bacteriostatic to most susceptible microorganisms; binds to the 50S bacterial ribosomal subunits and inhibits bacterial growth by inhibiting protein synthesis. Not preferred therapy for treating patients with typhus.

Adult

0.5-1 g IV q6h; not to exceed 4 g/d

Pediatric

80-100 mg/kg/d IV divided q6h

May increase the level/effects of anticoagulants, barbiturates, cyclophosphamide, phenytoin, and sulfonylureas; may reduce effects of iron salts and vitamin B-12; barbiturates, phenytoin, and rifampin may reduce chloramphenicol levels

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

At term or during labor, may cause gray baby syndrome in neonates, optic atrophy, ophthalmoplegia, peripheral neuritis, and disulfiramlike reaction; should only be used to treat serious infections; may cause blood dyscrasias such as granulocytopenia, thrombocytopenia, reticulocytopenia, anemia; discontinue upon appearance of these dose-related findings; aplastic anemia is an idiosyncratic response to chloramphenicol and is not dose related, and may occur after the antibiotic is discontinued; prolonged therapy can be toxic in patients with severely impaired liver function

More on Typhus

Overview: Typhus
Differential Diagnoses & Workup: Typhus
Treatment & Medication: Typhus
Follow-up: Typhus
References
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References

  1. Reynolds MG, Krebs JS, Comer JA, et al. Flying squirrel-associated typhus, United States. Emerg Infect Dis. Oct 2003;9(10):1341-3. [Medline].

  2. Boostrom A, Beier MS, Macaluso JA, et al. Geographic association of Rickettsia felis-infected opossums with human murine typhus, Texas. Emerg Infect Dis. Jun 2002;8(6):549-54. [Medline].

  3. Civen R, Ngo V. Murine typhus: an unrecognized suburban vectorborne disease. Clin Infect Dis. Mar 15 2008;46(6):913-8. [Medline].

  4. Saah AJ. Orientia tsutsugamushi (Scrub typhus). In: Principles and Practice of Infectious Diseases. 2000:2056-2057.

  5. Wongchotigul V, Waicharoen S, Riengrod S, et al. Development and evaluation of a latex agglutination test for the rapid diagnosis of scrub typhus. Southeast Asian J Trop Med Public Health. Jan 2005;36(1):108-12. [Medline].

  6. Watt G, Kantipong P, Jongsakul K, et al. Doxycycline and rifampicin for mild scrub-typhus infections in northern Thailand: a randomised trial. Lancet. Sep 23 2000;356(9235):1057-61. [Medline].

  7. Kim YS, Yun HJ, Shim SK, et al. A comparative trial of a single dose of azithromycin versus doxycycline for the treatment of mild scrub typhus. Clin Infect Dis. Nov 1 2004;39(9):1329-35. [Medline].

  8. Christie AB. Rickettsial disease: typhus. In: Infectious Diseases: Epidemiology and Clinical Practice. 2. 1987:1070-1097.

  9. Dumler JS, Walker DH. Rickettsia typhi (Murine typhus). In: Principles and Practice of Infectious Diseases. 2000:2053-55.

  10. Fergie JE, Purcell K, Wanat D. Murine typhus in South Texas children. Pediatr Infect Dis J. Jun 2000;19(6):535-8. [Medline].

  11. Higgins JA, Azad AF. Murine flea-borne typhus. In: Hunter GW, Thomas SG, eds. Hunter's Tropical Medicine and Emerging Infectious Diseases. 8th ed. Philadelphia, Pa: WB Saunders and Co; 2000:434-5.

  12. La Scola B, Raoult D. Laboratory diagnosis of rickettsioses: current approaches to diagnosis of old and new rickettsial diseases. J Clin Microbiol. Nov 1997;35(11):2715-27. [Medline].

  13. Olson JG. Typhus: general principles. In: Hunter GW, Thomas SG, eds. Hunter's Tropical Medicine and Emerging Infectious Diseases. 8th ed. Philadelphia, Pa: WB Saunders and Co; 2000:430-3.

  14. Raoult D, Roux V. Rickettsioses as paradigms of new or emerging infectious diseases. Clin Microbiol Rev. Oct 1997;10(4):694-719. [Medline].

  15. Saah AJ. Rickettsia prowazekii (epidemic or louse-borne typhus). In: Principles and Practice of Infectious Diseases. 2000:2050-2053.

  16. Watt G, Olson JG. Scrub typhus. In: Hunter GW, Thomas SG, eds. Hunter's Tropical Medicine and Emerging Infectious Diseases. 8th ed. Philadelphia, Pa: WB Saunders and Co; 2000:443-5.

  17. Watt G, Parola P. Scrub typhus and tropical rickettsioses. Curr Opin Infect Dis. Oct 2003;16(5):429-36. [Medline].

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Further Reading

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Keywords

typhus, epidemic typhus, rickettsemia, louse-borne typhus, classic typhus, Brill-Zinsser disease, recrudescence of epidemic typhus, murine typhus, flea-borne typhus, endemic typhus, scrub typhus, tsutsugamushi fever, rickettsial infection, Pediculus corporis, Rickettsia prowazekii, R prowazekii, Rickettsia felis, R felis, Pediculus capitis, Phthirus pubis, Xenopsylla cheopis, Ctenocephalides felis, Leptotrombidium akamushi, Leptotrombidium deliense, Dermacentor andersoni, Dermacentor variabilis, Amblyomma americanum, Orientia tsutsugamushi, O tsutsugamushi, Rickettsia typhi, R typhi, Rickettsia tsutsugamushi, R tsutsugamushi, Rocky Mountain spotted fever, RMSF

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Contributor Information and Disclosures

Author

Jason F Okulicz, MD, Assistant Professor of Medicine, Uniformed Services University of the Health Sciences; Staff, Infectious Disease Service, Brooke Army Medical Center
Jason F Okulicz, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Coauthor(s)

Mark S Rasnake, MD, Assistant Professor of Medicine, Program Director, Internal Medicine Residency, University of Tennessee Graduate School of Medicine; Consulting Staff, Department of Infectious Diseases, University of Tennessee Medical Center at Knoxville
Mark S Rasnake, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Eric A Hansen, DO, Fellow, Clinical Instructor, Department of Internal Medicine, Division of Infectious Diseases, Winthrop-University Hospital, State University of New York at Stony Brook
Eric A Hansen, DO is a member of the following medical societies: American Medical Association, American Osteopathic Association, Infectious Diseases Society of America, and Undersea and Hyperbaric Medical Society
Disclosure: Nothing to disclose.

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Medical Editor

John M Leedom, MD, Professor of Medicine, Keck School of Medicine, University of Southern California; Chief, Division of Infectious Diseases, Department of Internal Medicine, Los Angeles County, University of Southern California Medical Center
John M Leedom, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Thomas M Kerkering, MD, Chief of Infectious Diseases, Virginia Tech, Carilion School of Medicine, Roanoke, Virginia
Thomas M Kerkering, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Public Health Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Medical Society of Virginia, and Wilderness Medical Society
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD, Professor, Stewart G Wolf Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center
Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Association of Professors of Medicine, Association of Program Directors in Internal Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

 
 
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