Indian researchers identify better drug for treating severe scrub typhus

Severe scrub typhus is a life-threatening infection caused by the bacteria, Orientia tsutsugamushi. This infection, which primarily affects rodents, is transmitted to humans (zoonoses) by the larvae of trombiculid mites. 

An Indian multi-institute team of researchers have identified a better drug treatment for severe scrub typhus, a life-threatening infection caused by the bacteria, Orientia tsutsugamushi. This infection, which primarily affects rodents, is transmitted to humans (zoonoses) by the larvae of trombiculid mites. 

The researchers found that a combination antibiotic treatment (using a combination of drugs) is more effective for treating severe scrub typhus than single-drug therapies. 

Billion people at risk of contracting scrub typhus

Scrub typhus is a major public health threat in India and other South Asian countries. It is estimated that in endemic regions, about a billion people are at risk of contracting the infection, while a million people get infected and 1.5 lakh people die from it every year. 

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, has been published 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 George M Varghese, Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, said, “The implication of this study is that when using a combination of azithromycin and doxycycline to treat severe scrub typhus, more patients can be discharged from the hospital by day 7 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.” 

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