Phimda Kriangsak, Hoontrakul Siriwan, Suttinont Chuanpit, Chareonwat Sompong, Losuwanaluk Kitti, Chueasuwanchai Sunee, Chierakul Wirongrong, Suwancharoen Duangjai, Silpasakorn Saowaluk, Saisongkorh Watcharee, Peacock Sharon J, Day Nicholas P J, Suputtamongkol Yupin
Udonthani Hospital, Udonthani Province, Thailand.
Antimicrob Agents Chemother. 2007 Sep;51(9):3259-63. doi: 10.1128/AAC.00508-07. Epub 2007 Jul 16.
Leptospirosis and scrub typhus are important causes of acute fever in Southeast Asia. Options for empirical therapy include doxycycline and azithromycin, but it is unclear whether their efficacies are equivalent. We conducted a multicenter, open, randomized controlled trial with adult patients presenting with acute fever (<15 days), without an obvious focus of infection, at four hospitals in Thailand between July 2003 and January 2005. Patients were randomly allocated to receive either a 7-day course of doxycycline or a 3-day course of azithromycin. The cure rate, fever clearance time, and adverse drug events were compared between the two study groups. A total of 296 patients were enrolled in the study. The cause of acute fever was determined for 151 patients (51%): 69 patients (23.3%) had leptospirosis; 57 patients (19.3%) had scrub typhus; 14 patients (4.7%) had murine typhus; and 11 patients (3.7%) had evidence of both leptospirosis and a rickettsial infection. The efficacy of azithromycin was not inferior to that of doxycycline for the treatment of both leptospirosis and scrub typhus, with comparable fever clearance times in the two treatment arms. Adverse events occurred more frequently in the doxycycline group than in the azithromycin group (27.6% and 10.6%, respectively; P = 0.02). In conclusion, doxycycline is an affordable and effective choice for the treatment of both leptospirosis and scrub typhus. Azithromycin was better tolerated than doxycycline but is more expensive and less readily available.
钩端螺旋体病和恙虫病是东南亚地区急性发热的重要病因。经验性治疗的选择包括多西环素和阿奇霉素，但它们的疗效是否相当尚不清楚。2003年7月至2005年1月期间，我们在泰国的四家医院对出现急性发热（<15天）、无明显感染灶的成年患者进行了一项多中心、开放、随机对照试验。患者被随机分配接受为期7天的多西环素疗程或为期3天的阿奇霉素疗程。比较了两个研究组的治愈率、发热消退时间和药物不良事件。共有296名患者纳入研究。确定了151名患者（51%）急性发热的病因：69名患者（23.3%）患有钩端螺旋体病；57名患者（19.3%）患有恙虫病；14名患者（4.7%）患有鼠型斑疹伤寒；11名患者（3.7%）有钩端螺旋体病和立克次体感染的证据。阿奇霉素治疗钩端螺旋体病和恙虫病的疗效不低于多西环素，两个治疗组的发热消退时间相当。多西环素组的不良事件发生率高于阿奇霉素组（分别为27.6%和10.6%；P = 0.02）。总之，多西环素是治疗钩端螺旋体病和恙虫病的一种经济有效的选择。阿奇霉素的耐受性优于多西环素，但价格更高且更难获得。
