Scrub Typhus Medication

Updated: Apr 19, 2018
  • Author: David J Cennimo, MD, FAAP, FACP, FIDSA, AAHIVS; Chief Editor: Russell W Steele, MD  more...
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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. [72] Telithromycin is a promising new antibacterial agent for patients with scrub typhus.



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 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 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.