Antibiotics for treating scrub typhus

 

Abstract

Background

Scrub typhus is a bacterial disease in regions of Asia and the Pacific. Antibiotics (chloramphenicol, tetracycline, and doxycycline) have been used to treat the disease. Resistance to these antibiotics has been reported.

Objectives

To evaluate antibiotic regimens for treating scrub typhus.

Search methods

We searched the Cochrane Infectious Diseases Group specialized trials register (January 2010); CENTRAL (The Cochrane Library, Issue 4, 2009); MEDLINE (1966 to January 2010); EMBASE (1980 to January 2010); LILACS (1982 to January 2010); mRCT (January 2010). We checked references and contacted authors for additional data.

Selection criteria

Randomized and quasi-randomized studies comparing antibiotic regimens in people diagnosed with scrub typhus.

Data collection and analysis

Both authors screened the search results, assessed eligibility, quality and extracted data. We used Review Manager (Version 5.0.2), and expressed results as Relative Risk (binary) or weighted mean difference (continuous), with 95% confidence intervals.

Main results

Seven small trials met the inclusion criteria. In one trial, no difference was detected between tetracycline and chloramphenicol in relation to fever at 48 hours (1 patient febrile in each arm; N=60). No difference was detected in two trials that compared doxycycline and tetracycline. Rifampicin was more effective than doxycycline in one trial (participants febrile at 48 hours, RR 0.41, 95% CI 0.22 to 0.77). No difference was detected in two trials evaluated azithromycin against doxycycline, with no difference in fever at 48 hours (RR 1.22, 95% CI 0.17 to 8.92; 150 participants). One trial compared telithromycin with doxycycline, and the effects were similar. No trials reported death or serious complications.

Authors' conclusions

Data are limited because trials are small. There are no obvious differences between tetracycline, doxycycline, telithromycin,or azithromycin; rifampicin may be better than tetracycline in areas where scrub typhus appears to respond poorly to standard anti-rickettsial drugs.

 

Plain language summary

Antibiotics for treating scrub typhus

Scrub typhus is transmitted by chiggers (mites), is a bacterial infection and causes fever and a typical sore on the skin, and is common in the western Pacific region and many parts of Asia, particularly in agricultural workers and travellers in areas where the disease is common, particularly people camping, rafting, or trekking . This review summarize the information from seven small trials about the effects of antibiotics on scrub typhus. Most of the antibiotics tested worked: this includes: doxycycline, tetracycline, telithromycin and azithromycin. Rifampicin seem to be more effective than doxycycline in areas where scrub typhus appears to respond poorly to standard anti-rickettsial drugs.

 

摘要

背景

抗生素用於治療恙蟲病的療效評估

恙蟲病是一種細菌性疾病，分佈在亞洲和太平洋地區，抗生素chloramphenicol, tetracycline,及doxycycline已被用來治療該疾病。有報告顯示此細菌對這些抗生素有抗藥性。

目標

評估以抗生素來治療恙蟲病的效果。

搜尋策略

我們搜查了Cochrane傳染病組專門試驗註冊(2004年8月);CENTRAL(Cochrane圖書館，第3期，2004年);MEDLINE(1966年至2004年8月); EMBASE(1988年至2004年8月); LILACS(2004年8月)。我們檢查了文章中的參考文獻，並和作者連絡，得到額外的數據。

選擇標準

隨機和準隨機研究中有比較抗生素在被診斷出為患有恙蟲病者的治療。

資料收集與分析

一位回顧者篩選搜索的結果，兩位回顧者都評估試驗是否符合條件、試驗品質，並擷取數據。我們利用Review Manager(4.1版)軟體來分析資料，並用RR(類別變項)或加權平均差(連續變項)，以95 ％CI來呈現其結果。

主要結論

4個試驗有451成人符合納入標準，1個小研究並沒有證實出tetracycline與chloramphenicol的差異(受試者在48小時後沒有發燒，RR為1.00 ; 95 ％CI為0.07至15.26)。兩個小試驗並沒有顯示出doxycycline和tetracycline的差異(受試者在48小時後沒有發燒，RR為0.46 ; 95 ％CI為0.12至1.75)。1個試驗顯示rifampicin比doxycycline更有效(在去除發燒方面，RR為0.41 ; 95 ％CI為0.22至0.77;每一組病人都沒有復發)。

作者結論

在tetracycline和doxycycline的治療上有限的數據並沒有呈現出明顯差異。有限的數據顯示rifampicin對於恙蟲病出現的地區、且用傳統抗立克次體藥物效果不佳時似乎有效。

翻譯人

本摘要由三軍總醫院盧俊吉翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

總結未定