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Scrub Typhus Medication

  • Author: David J Cennimo, MD, FAAP, FACP, AAHIVS; Chief Editor: Russell W Steele, MD  more...
 
Updated: Oct 01, 2015
 

Medication Summary

Antibiotics are necessary to eradicate Orientia tsutsugamushi infection. Doxycycline is of proven efficacy, though resistance has been documented in parts of northern Thailand. Macrolides are equally efficacious. Azithromycin is desirable for pregnant women and for children. Rifampin is often used where doxycycline resistance is present. Telithromycin is a promising new antibacterial agent for patients with scrub typhus.

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Antibiotics

Class Summary

Tetracycline derivatives (eg, doxycycline) are the mainstays of scrub typhus treatment. Chloramphenicol is also used. Rifampin and azithromycin have been used successfully in areas where scrub typhus is resistant to conventional therapy. The efficacy and safety of a 5-day telithromycin regimen has compared favorably with those of a 5-day doxycycline regimen.

Tetracycline

 

Tetracycline inhibits bacterial protein synthesis by binding with 30S and possibly 50S ribosomal subunits.

Doxycycline (Doxy 100, Doryx, Vibramycin, Adoxa, Oraxyl)

 

Doxycycline is a synthetic antibiotic derived from tetracycline. It inhibits protein synthesis and thus bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria. It is effective against a large number of pathogens.

Chloramphenicol

 

Chloramphenicol binds to 50S ribosomal subunits of bacteria and inhibits bacterial growth by inhibiting protein synthesis. Oral chloramphenicol is no longer available in the United States. Serum levels must be closely monitored and the dosage appropriately adjusted to achieve therapeutic concentrations (peak, 10-20 µg/mL; trough, 5-10 µg/mL).

Azithromycin (Zithromax, Zmax)

 

Azithromycin inhibits bacterial growth, possibly by blocking the dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

Rifampin (Rifadin)

 

Rifampin inhibits DNA-dependent bacterial (but not mammalian) RNA polymerase activity in susceptible cells. No known cross-resistance of microbes occurs, except when other rifamycins are involved. Rifampin is readily absorbed after oral dosing. Renal and hepatobiliary routes of elimination are active.

Telithromycin (Ketek)

 

Telithromycin inhibits bacterial protein synthesis by binding the 50S ribosomal subunit at 2 sites.

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Contributor Information and Disclosures
Author

David J Cennimo, MD, FAAP, FACP, AAHIVS Assistant Professor of Medicine and Pediatrics, Adult and Pediatric Infectious Diseases, Director, Disease Processes, Prevention, and Therapeutics, Director, Pediatric Infectious Diseases Fellowship, Rutgers New Jersey Medical School

David J Cennimo, MD, FAAP, FACP, AAHIVS is a member of the following medical societies: American Academy of Pediatrics, American College of Physicians, American Medical Association, Infectious Diseases Society of America, Medical Society of New Jersey, Pediatric Infectious Diseases Society, HIV Medicine Association, American Academy of HIV Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Arry Dieudonne, MD Associate Professor of Pediatrics, Division of Pulmonology, Allergy, Immunology and Infectious Diseases, Rutgers New Jersey Medical School; Clinical Director, Francois-Xavier Bagnold Center for Children, University Hospital

Arry Dieudonne, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

David F Butler, MD Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Rosalie Elenitsas, MD Herman Beerman Associate Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System

Rosalie Elenitsas, MD is a member of the following medical societies: American Academy of Dermatology and American Society of Dermatopathology

Disclosure: Lippincott Williams Wilkins Royalty Textbook editor; DLA Piper Consulting fee Consulting

Janet Fairley, MD Professor and Head, Department of Dermatology, University of Iowa, Roy J and Lucille A Carver College of Medicine

Janet Fairley, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Federation for Medical Research, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Aracelis D Fernandez, MD, FAAP Attending Physician, Assistant Professor of Pediatrics, Assistant Professor of Immunology an, Department of Pediatrics, Children's Hospital at Albany Medical Center

Aracelis D Fernandez is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Cris Jagar MD, Staff Physician, Department of Psychiatry, Trinitas Regional Medical Center

Disclosure: Nothing to disclose.

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

Rosemary Johann-Liang, MD Medical Officer, Infectious Diseases and Pediatrics, Division of Special Pathogens and Immunological Drug Products, Center for Drug Evaluation and Research, Food and Drug Administration

Rosemary Johann-Liang, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Larry I Lutwick, MD Professor of Medicine, State University of New York Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus

Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

José Rafael Romero, MD Director of Pediatric Infectious Diseases Fellowship Program, Associate Professor, Department of Pediatrics, Combined Division of Pediatric Infectious Diseases, Creighton University/University of Nebraska Medical Center

José Rafael Romero, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, New York Academy of Sciences, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

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Transmission electron micrograph depicts peritoneal mesothelial cell of mouse that had been experimentally infected intraperitoneally with Orientia tsutsugamushi. Several organisms are visible within mesothelial cell's cytoplasm.
Eschar on neck.
Eschar on scrotum.
Typical eschar.
Maculopapular rash.
Chigger. Image taken from "Food and Environmental Hygiene Department" Web site and is reproduced under license from the Government of Hong Kong Special Administrative Region.
 
 
 
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