While doxycycline is the drug of choice in the treatment of scrub typhus, research for effective alternative agents are required. In this open-label randomised control trial, the authors compared doxycycline 100 mg twice daily for 5 days (121 cases) and rifampin 600 mg once daily for 5 days (119 cases) for scrub typhus patients (total 240 cases) admitted to Hospitals in the Republic of Korea between 2007 and 2009. Confirmed scrub typhus was defined as Scrub typhus IgM positivity or PCR positivity from the buffy coat or eschar. Severe scrub typhus was not included in the study. Only two third of the patients included had lab confirmed scrub typhus. The primary outcome – fever defervescence was same in both the groups. There was no significant difference in the occurrence of side effects following drug administration between groups.
This trial suggests that rifampin could be used as an alternative agent in the treatment of non severe scrub typhus, especially among children, pregnant women and those with contra-indications to doxycycline.