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In vitro Synergism between Chloroquine and Antibiotics against Orientia tsutsugamushi.
[scrub typhus]
To
investigate
whether
chloroquine
enhances
the
effect
of
antibiotics
against
Orientia
tsutsugamushi
,
the
causative
organism
of
scrub
typhus
,
we
compared
the
effect
of
antibiotics
in
combination
with
chloroquine
with
the
effect
of
antibiotics
alone
in
vitro
.
The
Boryong
or
AFSC-
4
strain
was
inoculated
into
ECV
304
cells
,
and
incubated
in
medium
containing
doxycycline
(
4
µg
/
mL
)
,
rifampin
(
4
µg
/
mL
)
,
azithromycin
(
0
.
5
µg
/
mL
)
,
chloroquine
(
1
µg
/
mL
)
,
and
each
of
these
antibiotics
in
combination
with
chloroquine
for
7
d
.
Immunofluorescence
(
IF
)
staining
for
O
.
tsutsugamushi
was
performed
4
hr
and
7
d
after
inoculation
of
the
bacteria
,
and
IF-
positive
foci
were
enumerated
.
Chloroquine
inhibited
the
growth
of
O
.
tsutsugamushi
by
15
.
5
%
.
In
combination
with
chloroquine
,
the
antimicrobial
effects
increased
by
4
.
4
%
for
doxycycline
(
a
92
.
9
%
reduction
of
bacterial
numbers
for
doxycycline
versus
a
97
.
3
%
reduction
for
doxycycline
plus
chloroquine
)
,
4
.
6
%
for
rifampin
(
90
.
0
%
versus
94
.
6
%
)
,
and
8
.
3
%
for
azithromycin
(
86
.
9
%
versus
95
.
2
%
)
.
The
antimicrobial
effect
of
the
antibiotics
alone
was
significantly
different
compared
to
the
combined
effect
of
antibiotics
and
chloroquine
(
Wilcoxon
signed-rank
test
,
P
=
0
.
001
)
.
The
combined
use
of
chloroquine
with
an
antibiotic
for
the
treatment
of
O
.
tsutsugamushi
infections
may
be
useful
for
increasing
the
efficacy
of
the
antibiotics
.
Diseases
Validation
Diseases presenting
"combined effect of antibiotics and chloroquine"
symptom
scrub typhus
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