Intravenous Doxycycline, Azithromycin, or Both for Severe Scrub Typhus.
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Varghese George M, Dayanand Divya, Gunasekaran Karthik, Kundu Debasree, Wyawahare Mukta, Sharma Navneet, Chaudhry Dhruva, Mahajan Sanjay K, Saravu Kavitha, Aruldhas Blessed W, Mathew Binu S, Nair Roshini G, Newbigging Nalini, Mathew Aswathy, Abhilash Kundavaram P P, Biswal Manisha, Prasad Ann H, Zachariah Anand, Iyadurai Ramya, Hansdak Samuel G, Sathyendra Sowmya, Sudarsanam Thambu D, Prakash John A J, Manesh Abi, Mohan Alladi, Tarning Joel, Blacksell Stuart D, Peerawaranun Pimnara, Waithira Naomi, Mukaka Mavuto, Cheah Phaik Yeong, Peter John V, Abraham Ooriapadickal C, Day Nicholas P J, INTREST Trial Investigators
Аннотация
METHODS: In this multicenter, double-blind, randomized, controlled trial, we compared the efficacy of intravenous doxycycline, azithromycin, or a combination of both in treating severe scrub typhus. Patients who were 15 years of age or older with severe scrub typhus with at least one organ involvement were enrolled. The patients were assigned to receive a 7-day course of intravenous doxycycline, azithromycin, or both (combination therapy). The primary outcome was a composite of death from any cause at day 28, persistent complications at day 7, and persistent fever at day 5.
RESULTS: Among 794 patients (median age, 48 years) who were included in the modified intention-to-treat analysis, complications included those that were respiratory (in 62%), hepatic (in 54%), cardiovascular (in 42%), renal (in 30%), and neurologic (in 20%). The use of combination therapy resulted in a lower incidence of the composite primary outcome than the use of doxycycline (33% and 47%, respectively), for a risk difference of -13.3 percentage points (95% confidence interval [CI], -21.6 to -5.1; P = 0.002). The incidence with combination therapy was also lower than that with azithromycin (48%), for a risk difference of -14.8 percentage points (95% CI, -23.1 to -6.5; P<0.001). No significant difference was seen between the azithromycin and doxycycline groups (risk difference, 1.5 percentage points; 95% CI, -7.0 to 10.0; P = 0.73). The results in the per-protocol analysis were similar to those in the primary analysis. Adverse events and 28-day mortality were similar in the three groups.
CONCLUSIONS: Combination therapy with intravenous doxycycline and azithromycin was a better therapeutic option for the treatment of severe scrub typhus than monotherapy with either drug alone. (Funded by the India Alliance and Wellcome Trust; INTREST Clinical Trials Registry-India number, CTRI/2018/08/015159.).