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Outcome of intravenous azithromycin therapy in patients with complicated scrub typhus compared with that of doxycycline therapy using propensity-matched analysis.
[scrub typhus]
There
are
no
well-matched
,
controlled
studies
comparing
azithromycin
with
doxycycline
for
the
treatment
of
complicated
scrub
typhus
.
A
retrospective
propensity
score-matched
case-control
study
was
performed
for
patients
who
presented
with
complicated
scrub
typhus
and
were
treated
with
doxycycline
or
azithromycin
between
2001
and
2011
.
Data
on
comorbidities
,
clinical
manifestations
,
laboratory
studies
,
treatments
,
and
outcomes
were
extracted
for
analysis
.
The
clinical
characteristics
and
outcomes
of
the
azithromycin-treated
group
(
n
=
73
)
were
compared
to
those
of
the
doxycycline-treated
group
(
n
=
108
)
.
Of
181
patients
,
73
from
each
group
were
matched
by
propensity
scores
.
There
were
no
significant
differences
in
baseline
characteristics
between
the
matched
groups
.
The
treatment
success
and
survival
rates
were
not
significantly
different
(
89
%
[
65
/
73
patients
]
versus
96
%
[
70
/
73
patients
]
and
96
%
[
70
/
73
patients
]
versus
96
%
[
70
/
73
patients
]
,
respectively
[
P
>
0
.
05
]
)
.
No
difference
was
observed
in
the
time
to
defervescence
or
length
of
hospital
stay
between
the
two
groups
(
P
>
0
.
05
)
.
In
complicated
scrub
typhus
patients
(
n
=
181
)
,
multivariate
analysis
showed
that
only
APACHE
II
score
was
an
independent
risk
factor
for
mortality
(
95
%
confidence
interval
,
1
.
11
to
1
.
56
;
P
<
0
.
001
)
.
Our
data
suggest
that
outcomes
of
azithromycin
therapy
are
comparable
to
those
of
doxycycline
therapy
in
patients
with
complicated
scrub
typhus
.