Typhus medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

The mainstay of therapy for rickettsial illnesses is antimicrobial therapy. Doxycycline is the drug of choice for louse borne and murine typhus.

• Louse born typhus, Rickettsia prowazekii (epidemic typhus, sylvatic typhus and Brill–Zinsser typhus ^[1]

• Pathogen-directed antimicrobial therapy

• In adults

• Preferred regimen (1): Doxycycline 200 mg PO for 5 days or 2-3 days after defervescence
• Preferred regimen (2): Doxycycline 100-200 mg PO single dose in outbreak situation
• Alternative regimen: Chloramphenicol 60 to 75 mg/kg/day PO in four divided doses

• In children

• Preferred regimen (1): Doxycycline 100-200 mg PO single dose

• In pregnant women

• Preferred regimen: Doxycycline 100-200 mg PO single dose

• Murine typhus,Rickettsia typhi (flea-borne infection) ^[1]

• Pathogen-directed antimicrobial therapy

• 1. Adults

• Preferred regimen : Doxycycline 100 mg PO bid continued for 3 days after the symptoms have resolved, Doxycycline 100-200 mg, PO single dose
• Alternative regimen (1): Oxacillin 2-12 g/24 hr IV q4-6h IV (maximum dose: 12 g/24)
• Alternative regimen (2): Chloramphenicol 60 to 75 mg/kg/day PO in qid

• 2. Children

• Preferred regimen: Doxycycline 100-200 mg, PO for 3-7 days
• Alternative regimen: Chloramphenicol 50-75 mg/kg/24 hr IV/PO q 6-8 hr

• 3. Pregnant women

• Preferred regimen: Doxycycline 100-200 mg, PO single dose ( late trimester)
• Alternative regimen (1): Erythromycin Base: 333 mg PO tid or estolate/stearate/ base: 250-500 mg PO qid
• Alternative regimen (2): Chloramphenicol 50 mg/kg/24 hr IV/PO q6h (maximum dose: 4 g/24 hr) (early trimester: first and second trimesters)

• Scrub typhus, Orientia tsutsugamushi (previously called Rickettsia tsutsugamushi- mite-borne infectious disease) ^[2]

• Pathogen-directed antimicrobial therapy

• Preferred regimen (1): Doxycycline 100 mg PO/IV q12h for 3 days
• Preferred regimen (2): Chloramphenicol 500 mg PO/IV q6h
• Alternative regimen: Azithromycin 500 mg PO day 1 followed by 250 mg for 4 days

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