๐ฆ๐ฐ๐ฟ๐๐ฏ ๐๐๐ฝ๐ต๐๐ is a devastating disease. At Sevagram, our healthcare providers regularly care for hundreds of patients with severe scrub typhus in the ICU. Unfortunately, around 15% of these patients do not survive.
A study from India published a day before in the ๐ก๐ฒ๐ ๐๐ป๐ด๐น๐ฎ๐ป๐ฑ ๐ ๐ ๐ฒ๐ฑ๐ถ๐ฐ๐ถ๐ป๐ฒ caught my attention. CMC Vellore, PGI Chandigarh and JIPMER, Puducherry were some of the institutes that participated in the study.
This multicenter, double-blind, randomized, controlled three-arm trial from India investigated which treatment (doxycycline, azithromycin, or their combination) was most effective in preventing death, complications, and fever.
The study enrolled 809 patients with severe scrub typhus, who were randomized to receive one of the three treatments for seven days while in the hospital. The researchers analyzed the data of 794 patients, with 265 in the doxycycline group, 263 in the azithromycin group, and 266 in the combination therapy group.
The median age of the patients was 48 years, and 54% were male. Additionally, 15% of the patients had diabetes mellitus, and 12% had hypertension. The patients in the study suffered from various complications, including respiratory problems (62%), hepatic issues (54%), cardiovascular issues (42%), renal problems (30%), and neurological problems (20%).
The researchers found that the patients who received the combination of doxycycline and azithromycin had a ๐ญ๐ฑ% ๐ฏ๐ฒ๐๐๐ฒ๐ฟ ๐ฐ๐ต๐ฎ๐ป๐ฐ๐ฒ ๐ผ๐ณ ๐ฑ๐ผ๐ถ๐ป๐ด ๐๐ฒ๐น๐น compared to those who received just one of the antibiotics.
Although the three groups did not differ in terms of the number of deaths (11% to 13%) or need for support systems like a ventilator or dialysis or inotrope support, the combination therapy was more effective overall in preventing complications and persistent fever. The time it took to get rid of the fever was similar in all three groups.
The researchers believe that using both antibiotics together may help prevent and resolve the severe symptoms of scrub typhus more quickly by better controlling the bacteria during the first week of infection. However, the exact reasons for this are still unknown, and more research is needed to fully understand the mechanism behind their findings.
In patients with severe scrub typhus, ๐ฑ๐ผ๐ ๐๐ฐ๐๐ฐ๐น๐ถ๐ป๐ฒ ๐ฝ๐น๐๐ ๐ฎ๐๐ถ๐๐ต๐ฟ๐ผ๐บ๐๐ฐ๐ถ๐ป ๐๐ฎ๐ ๐๐๐ฝ๐ฒ๐ฟ๐ถ๐ผ๐ฟ ๐๐ผ ๐ฒ๐ถ๐๐ต๐ฒ๐ฟ ๐๐ฟ๐ฒ๐ฎ๐๐บ๐ฒ๐ป๐ ๐ฎ๐น๐ผ๐ป๐ฒ in terms of a composite outcome of death, persistent complications, and persistent fever.
This study shows that using two antibiotics, doxycycline and azithromycin, together is more effective at fighting ๐. ๐ฉ๐จ๐ช๐ฉ๐จ๐ช๐๐๐ข๐ช๐จ๐๐โthe bacterium that causes scrub typhusโthan using just one antibiotic alone.
The reason for this is that the combination of antibiotics completely stops the bacterium from making proteins, which is crucial for its survival.
If the bacteria that causes scrub typhus is better controlled during the first week of infection, it’s possible that people could recover from severe symptoms more quickly.
O. tsutsugamushi is a tricky bacterium that can hide inside cells in the body, so it’s really important that the antibiotics get inside these cells too. Azithromycin is good at getting inside cells and staying there, which makes it very useful against this type of bacteria.
Of note, the combination therapy did not result in fewer deaths or reduced need for support systems in the ICU compared to using just one antibiotic. But it was still more effective overall in preventing complications and persistent fever.
We donโt know the reason why the antibiotic combo turned out to be more effective. We need further research to determine why.
The findings have the potential to change the way severe scrub typhus is treated in India.
Let me also calculate the cost of the treatment. To complete a 7-day therapy for scrub typhus at Sevagram hospital ICU, what would be the overall expense? The total cost would amount to ๐ฅ๐ ๐ฎ๐ฐ๐ญ๐ด, ๐๐ต๐ถ๐ฐ๐ต ๐ถ๐ป๐ฐ๐น๐๐ฑ๐ฒ๐ ๐ฅ๐ ๐ฎ๐ฌ๐ญ๐ฌ ๐ณ๐ผ๐ฟ ๐๐ผ๐ ๐๐ฐ๐๐ฐ๐น๐ถ๐ป๐ฒ ๐ฎ๐ป๐ฑ ๐ฅ๐ ๐ฐ๐ฌ๐ด ๐ณ๐ผ๐ฟ ๐๐๐ถ๐๐ต๐ฟ๐ผ๐บ๐๐ฐ๐ถ๐ป.