treatment

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Typhus is usually treated with:

  • tetracycline (e.g. doxycycline (2.2 mg/kg/dose bid PO or IV, maximum 200 mg/day for 7-15 days)) (1), OR,

  • chloramphenicol (50-100 mg/kg/day divided every 6 h IV, maximum 3 g/24 h, or 500 mg qid orally for 7-15 days for adults) (1)

Where resistance to these drugs is present, such as northern Thailand, rifampicin 900 mg daily may be given.

Treatment is continued for between one and two weeks.

The respective summary of product characteristics must be checked before prescribing any of the drugs mentioned.

Notes:

  • if used, chloramphenicol should be monitored to maintain serum concentrations of 10-30 µg/mL
    • therapy should be continued for a minimum of 5 days and until the patient has been afebrile for at least 3-4 days to avoid relapse
    • chloramphenicol is best avoided during pregnancy and reduced doses should be given in hepatic impairment

Reference:

  • Walker DH, Dumler JS, Marrie T. Rickettsial Diseases. (Part 8, Section 10, Chapter 174) In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, editors. Harrison's Principle of Internal Medicine. 18th ed. USA: The McGraw-Hill Companies; 2012. pp. 1064-5
  • Dumler JS, Siberry GK. Scrub Typhus (Orientia Tsutsugamushi). (Part XVI. Section 11. Chapter 226) In: Kliegman RM, Behrman Re, Jenson HB, Stanton BF, editors. Nelson Textbook of Pediatrics. 18th ed. Philadelphia: Saunders, Elsevier; 2007. pp. 1295-6.
  • Watts, G, Kantipong, P, et al. (2000). Doxycycline and rifampicin for mild scrub-typhus infections in northern Thailand: a randomised trial. Lancet, 356, 1057-61.

Last reviewed 01/2018