This retrospective observational study compared azithromycin and doxycycline for treatment of serologically confirmed scrub typhus in pediatric patients. The analysis focused on fever clearance time and other clinical outcomes to inform antibiotic choice in children aged 1–18 years managed at a tertiary care center in Chengalpattu.
The study covered a six-year period from January 2020 to January 2026 at a single tertiary care center in Chengalpattu. Eligible patients were pediatric (1–18 years) with serologically confirmed scrub typhus. A total of 120 patients were included and evenly divided into two treatment groups: 60 received azithromycin and 60 received doxycycline. Baseline demographic, clinical, and laboratory parameters were reported as comparable between groups.
The primary outcome was fever clearance time, defined as the time from initiation of antibiotic therapy to sustained defervescence. Secondary outcomes included duration of hospital stay, time to overall clinical improvement, complication rates (respiratory, neurological, hepatic), need for intensive care, and mortality. Statistical testing was performed using appropriate methods and significance was set at P < 0.05.
The study found that the doxycycline group had a significantly shorter fever clearance time compared with the azithromycin group. In addition to faster resolution of fever, patients treated with doxycycline experienced more rapid overall clinical improvement and had a reduced duration of hospital stay. These differences were reported as statistically significant in the study abstract.
The authors emphasize that doxycycline was associated with earlier recovery, while azithromycin remained effective but with longer time to fever resolution when compared with doxycycline.
Note: The abstract did not provide specific numeric values for median or mean fever clearance times, durations of hospital stay, or the exact P values; those details were not reported in the source abstract and therefore are not included here.
Complication rates, including respiratory, neurological, and hepatic involvement, were similar between the azithromycin and doxycycline groups according to the report. The proportion of patients requiring intensive care support and the observed mortality rates did not differ significantly between the two antibiotic cohorts.
These findings indicate that while doxycycline may shorten fever duration and accelerate recovery, major adverse clinical outcomes and the need for critical care were comparable across both treatment approaches in this pediatric series.
From the data reported, both antibiotics are effective options for pediatric scrub typhus. The principal clinical distinction reported in the abstract is the faster fever resolution and earlier clinical recovery associated with doxycycline. Given doxycycline’s association with more rapid improvement in this cohort, it may be preferred when clinical priorities include rapid defervescence and shorter hospitalization.
However, the abstract also highlights the role of azithromycin as a valuable alternative, particularly in younger children or settings where doxycycline use is limited or contraindicated. The similar rates of complications, intensive care need, and mortality across groups support azithromycin as an acceptable substitute from a safety and major-outcome perspective.
The authors underscore the broader clinical principle that early diagnosis and prompt initiation of appropriate antibiotic therapy are essential to reduce morbidity and prevent complications in pediatric scrub typhus.
In this retrospective cohort of 120 pediatric patients with serologically confirmed scrub typhus, both azithromycin and doxycycline appeared effective. Doxycycline was associated with significantly faster fever clearance and earlier clinical recovery and shorter hospital stays, whereas rates of complications, need for intensive care, and mortality were similar between groups. Azithromycin remains an important alternative when doxycycline use is constrained, particularly in younger pediatric patients. Early recognition and commencement of appropriate antibiotic therapy remain key messages.
For clinicians seeking numeric effect sizes, subgroup analyses, dosing regimens, or safety event details, consult the full article; those specific data were not available in the PubMed abstract.