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In vitro Antagonism between Cefotaxime and Anti-Rickettsial Antibiotics against Orientia tsutsugamushi.
[scrub typhus]
We
have
investigated
the
in
vitro
antimicrobial
effects
of
antibiotic
combinations
against
Orientia
tsutsugamushi
,
the
causative
agent
of
scrub
typhus
.
ECV
304
cells
were
infected
with
the
Boryong
strain
of
O
.
tsutsugamushi
and
incubated
in
a
medium
containing
doxycycline
(
4
µg
/
mL
)
,
azithromycin
(
0
.
5
µg
/
mL
)
,
rifampin
(
4
µg
/
mL
)
,
ciprofloxacin
(
25
µg
/
mL
)
,
gentamicin
(
5
µg
/
mL
)
,
cefotaxime
(
2
µg
/
mL
)
,
or
combinations
of
these
agents
for
7
days
,
after
which
immunofluorescent
staining
for
O
.
tsutsugamushi
was
performed
.
The
percentages
of
infective
foci
in
cultures
containing
antibiotics
compared
to
those
in
cultures
without
antibiotics
were
6
.
2
%
for
doxycycline
,
9
.
6
%
for
azithromycin
,
8
.
8
%
for
rifampin
,
96
.
6
%
for
cefotaxime
,
29
.
7
%
for
doxycycline
plus
cefotaxime
,
23
.
6
%
for
azithromycin
plus
cefotaxime
,
and
41
.
4
%
for
rifampin
plus
cefotaxime
.
These
findings
show
an
in
vitro
antagonism
between
anti-rickettsial
agents
and
cefotaxime
against
O
.
tsutsugamushi
.
These
results
suggest
that
the
efficacy
of
antibiotic
combinations
involving
cefotaxime
for
the
treatment
of
patients
with
scrub
typhus
,
particularly
those
with
severe
pneumonia
,
needs
to
be
investigated
.
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