Comparison of Oral Doxycycline and Azithromycin Effectiveness in Scrub Typhus: An Observational study

Background: Scrub typhus, a mite-borne infectious disease caused by Orientia tsutsugamushi, is a significant cause of acute febrile illness in endemic regions, particularly in Asia. Despite the availability of antibiotics, the optimal treatment regimen in pediatric patients remains a subject of ongoing research. Objective: To compare the efficacy of doxycycline and azithromycin in the treatment of scrub typhus. Methods: This study was conducted on 20 pediatric patients (≤12 years of age) presenting with fever lasting for seven or more days and confirmed scrub typhus infection in the Department of Paediatrics at Vinayaka Missions Medical College & Hospital, Karaikal, Puducherry. Results: The study included 20 pediatric patients diagnosed with scrub typhus, with 10 receiving azithromycin and 10 receiving doxycycline. The mean age of patients was comparable between the two groups, with no statistically significant difference (P = 0.098). Gender distribution was also similar, with the azithromycin group comprising seven males and three females, while the doxycycline group had five males and five females (P = 0.361). The mean fever clearance time was significantly longer in the azithromycin group (53.1 hours, SD: 2.0) compared to the doxycycline group (44.2 hours, SD: 2.1), with a statistically significant difference (P = 0.001). The mean duration of hospital stay was slightly longer in the azithromycin group (46.2 hours, SD: 4.0) compared to the doxycycline group (45.2 hours, SD: 4.2), but this difference was not statistically significant (P = 0.317). No mortality was reported in either treatment group (P = 1.000). However, adverse drug reactions were observed in two patients (20.0%) in the azithromycin group, while none were reported in the doxycycline group, a statistically significant finding (P = 0.045). These results indicate that doxycycline was more effective in achieving faster fever resolution and had fewer adverse drug reactions than azithromycin. Conclusion: Doxycycline is more efficacious in achieving fever defervescence and in preventing adverse drug reactions in patients with scrub typhus.