Department of Internal Medicine, National Hospital Organization Awara Hospital, Awara, Fukui, Japan; Division of Infection Control and Prevention, University of Fukui Hospital, Fukui, Japan.
Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan.
Int J Antimicrob Agents. 2023 Aug;62(2):106895. doi: 10.1016/j.ijantimicag.2023.106895. Epub 2023 Jun 18.
Although approximately 40 years have passed since Japanese spotted fever (JSF) was first reported in Japan, its treatment has not yet been standardised. As in other rickettsial infections, tetracycline (TC) is the first-line treatment, but successful instances of fluoroquinolone (FQ) combination therapy in severe cases have been reported. However, the effectiveness of TC plus FQ combined treatment (TC+FQ) remains controversial. Therefore, the antipyretic effect of TC+FQ was evaluated in this study.
A comprehensive search of published JSF case reports was conducted to extract individual patient data. In cases where it was possible to extract temperature data, after homogenising patient characteristics, time-dependent changes in fever type from the date of the first visit was evaluated for the TC and TC+FQ groups.
The primary search yielded 182 cases, with individual data evaluations resulting in a final analysis of 102 cases (84 in the TC group and 18 in the TC+FQ group) that included temperature data. The TC+FQ group had significantly lower body temperature compared with the TC group from Days 3 to 4.
Although TC monotherapy for JSF can eventually result in defervescence, the duration of fever is longer compared with other rickettsial infections such as scrub typhus. The results suggest that the antipyretic effect of TC+FQ was more effective, with a potential shortening of the duration that patients suffer from febrile symptoms.
日本斑疹热（JSF）在日本首次报告以来，已经过去了大约 40 年，但它的治疗方法尚未标准化。与其他立克次体感染一样，四环素（TC）是一线治疗药物，但已有报道称在严重病例中氟喹诺酮（FQ）联合治疗是有效的。然而，TC+FQ 联合治疗的有效性仍存在争议。因此，本研究评估了 TC+FQ 的退热效果。
对已发表的 JSF 病例报告进行了全面检索，以提取个体患者数据。在可以提取体温数据的情况下，对 TC 和 TC+FQ 组从首次就诊日期起发热类型的时间依赖性变化进行了评估，在对患者特征进行同质化后。
初步检索得到 182 例，对个体数据进行评估后，最终对 102 例（TC 组 84 例，TC+FQ 组 18 例）包括体温数据的病例进行了分析。TC+FQ 组从第 3 天到第 4 天的体温明显低于 TC 组。
尽管 JSF 的 TC 单药治疗最终可以退热，但与恙虫病等其他立克次体感染相比，发热时间更长。结果表明，TC+FQ 的退热效果更有效，可能缩短患者发热症状的持续时间。
