Severe scrub typhus infection: Clinical features, diagnostic challenges and management

Table 1 Commonly used antimicrobial agents in scrub typhus infection

Name of drug	Dose and administration in adults	Comments
Doxycycline[75,77]	100 mg twice daily for 7 d	Drug of choice Intravenous preferred for sicker patients Rapid defervescence within 48 h
Tetracycline[76]	500 mg four times daily	No difference between doxycycline and tetracycline
Azithromycin[75,77]	Mild infections: 500 mg single dose Severe infections: 500 mg once daily for 3 to 5 d; 1 g loading dose may be given	Preferred drug in pregnancy In mild cases symptom duration similar when compared with doxycycline Recommended when doxycycline resistance is present
Telithromycin[80]	800 mg daily for 5 d	As effective as doxycycline
Chloramphenicol[75,77]	500 mg every 6 h for 7 d	Most common alternative to tetracycline Contraindicated in pregnancy Risk of aplastic anemia
Rifampicin[78]	600 to 900 mg daily for 7 d	Combination with doxycycline not more efficacious than either Rifampicin or doxycycline in mild scrub typhus Shorter duration of fever with Rifampicin in Northern Thailand when compared with Doxycycline Caution in tuberculosis endemic areas