Azithromycin Versus Doxycycline for Pediatric Scrub Typhus: A Randomized Controlled Trial Comparing Clinical Efficacy and Safety Profiles

Abstract

Background: Scrub typhus remains a significant cause of febrile illness in children across endemic regions, with doxycycline being the conventional treatment despite safety concerns. This study compared the efficacy and safety of azithromycin versus doxycycline in pediatric scrub typhus.

Methods: A randomized controlled trial was conducted with 50 children (1-12 years) with confirmed scrub typhus, allocated to receive either single-dose azithromycin (10 mg/kg) or 7-day doxycycline (4.4 mg/kg/day). Primary outcome was time to fever defervescence; secondary outcomes included treatment failure rates, complications, adverse drug reactions (ADRs), and hospitalization duration.

Results: The azithromycin group demonstrated significantly faster fever resolution (24.5 ± 6.2 hours) compared to doxycycline (36.8 ± 8.4 hours; p = 0.003). Treatment failure occurred in 4% of azithromycin recipients versus 12% with doxycycline (p = 0.29). Complications were less frequent with azithromycin (8% vs. 20%; p = 0.23), and hospital stays were shorter (3.1 ± 1.0 vs. 4.5 ± 1.8 days; p = 0.02). ADRs, including vomiting (4% vs. 20%; p = 0.04) and transaminitis (0% vs. 12%; p = 0.04), were significantly lower in the azithromycin group.

Conclusion: Azithromycin showed superior clinical efficacy, faster recovery, and better tolerability than doxycycline in pediatric scrub typhus. These findings support its use as a first-line therapy, particularly in settings where doxycycline-related adverse effects or resistance are concerning. Further large-scale studies are warranted to validate these results.