Controlled Trial: 5-day Course of Telithromycin versus Doxycycline for the Treatment of Mild to Moderate Scrub Typhus.

Author(s): Kim DM, You KD, Lee JH, Kim HK, Lee SH

Affiliation(s): Division of Infectious Diseases, Department of Internal Medicine, Chosun University College of Medicine, Jangheung General Hospital, Cheomdan General Hospital, Departments of Pediatrics, Seonam University College of Medicine, Republic of Korea.

Publication date & source: 2007-04-02, Antimicrob Agents Chemother., [Epub ahead of print]

New antibiotics are required to have the antibacterial activity against doxycyline-resistant O. tsutsugamushi. An in vitro sensitivity study showed that telithromycin was more effective than erythromycin for Rickettsia, Bartonella and Coxiella burnetii. In this prospective, open-label, randomized trial, we enrolled patients with mild-to-moderate scrub typhus. We compared the efficacy and safety of a 5-day telithromycin therapy with those of a 5-day doxycycline therapy at Chosun University Hospital, or one of its two community-based affiliated hospitals (Jangheung Hospital and Chumdan Hospital) which are all located in southwestern Korea between September and December 2005. A total of 92 patients were randomly assigned to either telithromycin group (n=47) or doxycycline group (n=45). After the treatment, fever control time was 20.45+/-12.9 hours in the telithromycin group and 22.60+/-21.44 hours in the doxycycline group (p>0.05). After the treatment, the cure rate was 100% in the telithromycin group and 97.8% in the doxycycline group (p>0.05). Furthermore, there were no significant differences in time elapsed until such symptoms as headache, myalgia and rash have disappeared. No serious adverse events or death were noted following the treatment in both groups. There were no significant differences in adverse events In conclusion, the efficacy and safety of a 5-day qd regimen of telithromycin 800 mg were equivalent to those of a 5-day bid regimen of doxycline 100 mg in patients with mild-to-moderate scrub typhus. Telithromycin could be considered as a promising new antibacterial agent for patients with scrub typhus.