For Severe Scrub Typhus, Combination Therapy Is Better Than Monotherapy

Scrub typhus is endemic to Southeast and South Asia and Northern Australia and typically presents with fever, headache, altered sensorium, rash (including an eschar), and thrombocytopenia. Most cases are acquired in rural areas, where the transmitting mite is most common. For patients who develop severe scrub typhus, which is characterized by multiorgan dysfunction, the optimal therapy is not known. Therefore, investigators conducted a randomized trial to compare 7 days of intravenous doxycycline, azithromycin, or both in 794 patients hospitalized in India with severe scrub typhus.

Participants were severely ill at enrollment: Complications included respiratory (62%), hepatic (54%), cardiovascular (42%), renal (30%), and neurologic (20%) dys…