경증 및 중등도 쯔쯔가무시병환자에서 독시사이클린과 리팜핀의 치료효과에 관한 비교 연구

Abstract

(Background) Some strains of scrub typhus are poorly responsive to standard antirickettsial drugs. Therefore, new antibiotics are required to have the antibacterial activity doxycycline-resistant Orientia tsutsugamushi. Rifampin were the only antibiotics identified as more active than doxycycline against resistant strains of scrub typhus and were equally effective against drug-sensitive strains in mouse antibiotics susceptibility testing. We did a masked, randomized trial to compare rifampin with standard doxycycline therapy for patients with scrub typhus. (Method) In this prospective study, open-label, randomized trial, we enrolled patient with scrub typhus. We compaired the efficacy and safety of a 5-day doxycycline therapy with those of a 5-day Rifampin therapy at Chosun University Hospital or one of its three community-based affiliated hospitals(Cheomdan Hospital, Jangheung Hospital and Haenan Hospital), which are all located in southwestern Korea, between September and December, from 2006 to 2009. A total of 314 patient were randomly assigned to either the doxycycline group(n=174) or the rifampin group(n=140) (Result) After the treatment, fever control time was 19.27±17.66 in the doxycycline group and 17.53±14.94h in the rifampin group.(P>0.05) Rather, fever control time of rifampin group was shorter than doxycycline group. but, there were no significant differences in time elapsed until such symptoms as headache, myalgia, and rash disappeared. After the treatment, the cure rate was 98.2% in the doxycycline group and 99.2% in the rifampin group.(P>0.05). Serious adverse event, death were noted each one in both group and relapse were occurred in a patients treated with doxycycline(P>0.05 were no sinificant differences in adverse events in both group. (Conclusion) The efficacy and safety of a 5-day once-a-day regimen of 600mg rifampin were equivalent to those of a 5-day twice-a-day regimen of 100mg doxycycline in patients with scrub typhus. Rifampin could be considered a new antibacterial agent for patients with scrub typhus