Researchers at Christian Medical College in Vellore identify better drug treatment for scrub typhus

The research demonstrated that treatment with intravenous doxycycline and azithromycin is more effective than using either drug on its own

Prof George M Varghese, an infectious diseases physician and Researcher from Christian Medical College in Vellore, Tamil Nadu, and the INTREST trial investigators conducted a multi-centric, randomised controlled trial funded by the DBT/Wellcome India Alliance to identify the best treatment option for patients with severe scrub typhus. It demonstrated that treatment with intravenous doxycycline and azithromycin is more effective than using either drug on its own.

The new study, the largest ever randomised controlled trial on the treatment of severe scrub typhus, was published recently in The New England Journal of Medicine.

The collaborating institutions included the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Indira Gandhi Medical College & Hospital (IGMC) Shimla, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, Christian Medical College, Vellore, SVIMS Tirupati and KMC Manipal.

Prof Varghese said, “This study implies that when using a combination of azithromycin and doxycycline to treat severe scrub typhus, more patients can be discharged from the hospital by day seven as they would have fewer persisting complications, such as respiratory distress syndrome (ARDS), hepatitis, hypotension/shock, meningoencephalitis, and kidney failure. This trial provides evidence that combination therapy with intravenous doxycycline and azithromycin is a better therapeutic option for the treatment of severe scrub typhus than monotherapies of either drug. This new evidence will change treatment guidelines and save the lives of thousands of people with scrub typhus in the future.”

Prof Varghese added, “Scrub typhus typically presents as a fever that may be associated with headaches, coughs, shortness of breath, and brain symptoms, like confusion and disorientation. About six per cent of patients infected with scrub typhus could die despite diagnosis and treatment. One-third of patients develop a severe disease that affects multiple organs in the body and leads to lethally low blood pressure. Death rates in severe disease can reach up to 70 per cent without treatment and 24 per cent with treatment.”