Doxycycline is the drug of choice for treating scrub typhus. It should be administered as 100mg twice daily for 3-5 days after the fever subsides within 24-48 hours of starting treatment. For prolonged fevers, treatment should continue for 10 days. Doxycycline can be given intravenously for sick or hospitalized patients and is safe for children over 6 years old. Chloramphenicol and rifampicin are alternatives in pregnancy. Azithromycin or roxithromycin treat strains resistant to tetracyclines and chloramphenicol.

1. SCRUB TYPHUS

2. TREATMENT
• One should start the treatment as soon as possible on
suspicion of Rickettsial infection.
• All rickettsias are susceptible to tetracycline group and
Doxycycline is DOC.
• This is bacteriostatic.
• Given as 100mg twice a day.
• Fever subsides within 24-48 hours then given for 3-5 days
more.
• If fever remains for 5-7 days then continued till 10 days.
• IV doxycycline can be used in sick and hospitalised patients..
• Safe in children more than 6 years of age

3. • Chloramphenicol can be used as alternative drug but its side effects
and poorer antibacterial activity limits its use.
• Tertacyclines cannot be used in pregnancy because of malformations
of teeth and bones in fetus and hepatotoxicity and pancreatitis in
mothers.
• Chloramphenicol can be used in pregnancy except in third trimester
with fear of grey baby syndrome.
• Rifampicin can be used safely in pregnancy.

4. • Strains resistant to tetracyclines and chloramphenicol can be treated
with Azithromycin or Roxithromycin.
• Rifampicin can also be used.

5. REFERENCES
• HARRISSON’S PRINCIPLES OF INTERNAL MEDICINE 20TH EDITION
• API TEXTBOOK OF MEDICINE 11TH EDITION