Tigecycline versus Doxycycline for Scrub Typhus: A Preliminary Randomized Controlled Trial

초록

Background: Scrub typhus, caused by Orientia tsutsugamushi, remains a significant health concern in endemic regions. Although oral doxycycline is the standard treatment, alternative therapies are needed for patients requiring rapid clinical improvement or who are unable to tolerate oral medications. Methods: We conducted a prospective, multicenter randomized controlled trial involving 24 hospitalized patients with suspected scrub typhus. Patients were randomly assigned to receive either intravenous tigecycline or oral doxycycline. The primary outcome was the time to defervescence, defined as the time from antibiotic initiation to sustained fever resolution. Results: Tigecycline significantly shortened the median time to defervescence compared with doxycycline (10.4 vs. 38.9 hours; p=0.0079). No severe adverse events were reported in either group. Conclusion: Tigecycline demonstrated rapid antipyretic effects and favorable safety, suggesting it could be an effective alternative therapy for scrub typhus, especially in cases where oral administration is impractical or rapid fever control is critical. This research was supported by a grant from the National Institute of Health (Grant No. 2022-ER-210400, 2022-NI-036)