Typhus medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The mainstay of therapy for rickettsial illnesses is antimicrobial therapy. Doxycycline is the drug of choice for louse borne and murine typhus.
Medical Therapy
Pharmacotherapy
Typhus, louse-borne
- Louse born typhus, Rickettsia prowazekii (epidemic typhus, sylvatic typhus and Brill–Zinsser typhus [1]
- Pathogen-directed antimicrobial therapy
- In adults
- Preferred regimen (1): Doxycycline 200 mg PO for 5 days or 2-3 days after defervescence
- Preferred regimen (2): Doxycycline 100-200 mg PO single dose in outbreak situation
- Alternative regimen: Chloramphenicol 60 to 75 mg/kg/day PO in four divided doses
- In children
- Preferred regimen (1): Doxycycline 100-200 mg PO single dose
- In pregnant women
- Preferred regimen: Doxycycline 100-200 mg PO single dose
Typhus, murine
- Murine typhus,Rickettsia typhi (flea-borne infection) [1]
- Pathogen-directed antimicrobial therapy
- 1. Adults
- Preferred regimen : Doxycycline 100 mg PO bid continued for 3 days after the symptoms have resolved, Doxycycline 100-200 mg, PO single dose
- Alternative regimen (1): Oxacillin 2-12 g/24 hr IV q4-6h IV (maximum dose: 12 g/24)
- Alternative regimen (2): Chloramphenicol 60 to 75 mg/kg/day PO in qid
- 2. Children
- Preferred regimen: Doxycycline 100-200 mg, PO for 3-7 days
- Alternative regimen: Chloramphenicol 50-75 mg/kg/24 hr IV/PO q 6-8 hr
- 3. Pregnant women
- Preferred regimen: Doxycycline 100-200 mg, PO single dose ( late trimester)
- Alternative regimen (1): Erythromycin Base: 333 mg PO tid or estolate/stearate/ base: 250-500 mg PO qid
- Alternative regimen (2): Chloramphenicol 50 mg/kg/24 hr IV/PO q6h (maximum dose: 4 g/24 hr) (early trimester: first and second trimesters)
Typhus, scrub
- Scrub typhus, Orientia tsutsugamushi (previously called Rickettsia tsutsugamushi- mite-borne infectious disease) [2]
- Pathogen-directed antimicrobial therapy
- Preferred regimen (1): Doxycycline 100 mg PO/IV q12h for 3 days
- Preferred regimen (2): Chloramphenicol 500 mg PO/IV q6h
- Alternative regimen: Azithromycin 500 mg PO day 1 followed by 250 mg for 4 days
References
- ↑ 1.0 1.1 Botelho-Nevers E, Socolovschi C, Raoult D, Parola P (2012). "Treatment of Rickettsia spp. infections: a review". Expert Rev Anti Infect Ther. 10 (12): 1425–37. doi:10.1586/eri.12.139. PMID 23253320.
- ↑ Panpanich R, Garner P (2002). "Antibiotics for treating scrub typhus". Cochrane Database Syst Rev (3): CD002150. doi:10.1002/14651858.CD002150. PMID 12137646.