Trial reportClinical infectious diseases : an official publication of the Infectious Diseases Society of America2019
A Prospective, Open-label, Randomized Trial of Doxycycline Versus Azithromycin for the Treatment of Uncomplicated Murine Typhus.
Trial report in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 35 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
35 citing papers in PubMed, 2 syntheses or guidelines pooled it, 49 citations in OpenAlex.
- A systematic review of the untreated mortality of murine typhus.PLoS neglected tropical diseases · 2020Pooled it
- Selection of Diagnostic Cutoffs for Murine Typhus IgM and IgG Immunofluorescence Assay: A Systematic Review.The American journal of tropical medicine and hygiene · 2020Pooled it
- Trimethoprim-sulfamethoxazole Versus Azithromycin for the Treatment of Undifferentiated Febrile Illness in Nepal: A Double-blind, Randomized, Placebo-controlled Trial.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021Trial
- The temporal dynamics of humoral immunity to Rickettsia typhi infection in murine typhus patients.Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2020Trial
- Comparison ofMicrobiology spectrum · 2026Article
- Outcomes of Hospitalized and Critically Ill Adults with Murine Typhus, Galveston, Texas, USA, 2019-2023.Emerging infectious diseases · 2026Review
- Neglected rickettsial diseases in Southeast Asia: Twenty-five years of progress in surveillance, diagnostics, and clinical research.PLoS neglected tropical diseases · 2026Review
- A repetitive nucleotide insertion in the rplV gene is associated with in vitro resistance to azithromycin in Rickettsia typhi.PLoS neglected tropical diseases · 2026Article
- Bioinformatics analysis of Rickettsia typhi autoimmune associations and screening of Streptomyces-derived inhibitors.BioData mining · 2025Article
- Rickettsia felis meningoencephalitis in a 10-year-old child: a case report and literature review.BMC pediatrics · 2025Review
- Prevalence and risk factors for murine typhus, scrub typhus and spotted fever group rickettsioses among adolescent and adult patients presenting to Yangon General Hospital, Yangon, Myanmar.Tropical medicine & international health : TM & IH · 2025Article
- Ischemic Hepatitis and Septic Shock Secondary to Murine Typhus Infection in Pregnancy.AJP reports · 2024Article
- Gaps and inconsistencies in the current knowledge and implementation of biosafety and biosecurity practices for rickettsial pathogens.BMC infectious diseases · 2024Review
- Case Report: Cardiovascular Manifestations due to Flea-Borne Typhus.The American journal of tropical medicine and hygiene · 2024Review
- Flea-Borne Typhus as a COVID-19 Mimic: A Report of Four Cases.Case reports in infectious diseases · 2024Article
- Murine Typhus: A Review of a Reemerging Flea-Borne Rickettsiosis with Potential for Neurologic Manifestations and Sequalae.Infectious disease reports · 2023Review
- Article
- Incidence of tick-borne spotted fever group Rickettsia species in rodents in two regions in Kazakhstan.Scientific reports · 2022Article
- Systematic Surveillance of Rickettsial Diseases in 27 Hospitals from 26 Provinces throughout Vietnam.Tropical medicine and infectious disease · 2022Article
- Simple clinical and laboratory predictors to improve empirical treatment strategies in areas of high scrub typhus and dengue endemicity, central Vietnam.PLoS neglected tropical diseases · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
23 authors at 5 institutions in 4 countries.
Funding
Abstract
backgroundMurine typhus, or infection with Rickettsia typhi, is a global but neglected disease without randomized clinical trials to guide antibiotic therapy.
methodsA prospective, open, randomized trial was conducted in nonpregnant, consenting inpatient adults with rapid diagnostic test evidence of uncomplicated murine typhus at 2 hospitals in Vientiane, Laos. Patients were randomized to 7 days (D7) or 3 days (D3) of oral doxycycline or 3 days of oral azithromycin (A3). Primary outcome measures were fever clearance time and frequencies of treatment failure and relapse.
resultsBetween 2004 and 2009, the study enrolled 216 patients (72 per arm); 158 (73.2%) had serology/polymerase chain reaction (PCR)-confirmed murine typhus, and 52 (24.1%) were R. typhi PCR positive. The risk of treatment failure was greater for regimen A3 (22.5%; 16 of 71 patients) than for D3 (4.2%; 3 of 71) or D7 (1.4%; 1 of 71) (P < .001). Among R. typhi PCR-positive patients, the area under the time-temperature curve and the fever clearance time were significantly higher for A3 than for D3 (1.8- and 1.9-fold higher, respectively; P = .005) and D7 (1.5- and 1.6-fold higher; P = .02). No patients returned with PCR-confirmed R. typhi relapse.
conclusionIn Lao adults, azithromycin is inferior to doxycycline as oral therapy for uncomplicated murine typhus. For doxycycline, 3- and 7-day regimens have similar efficacy. Azithromycin use in murine typhus should be reconsidered. Investigation of genomic and phenotypic markers of R. typhi azithromycin resistance is needed. CLINICAL
trial registrationISRCTN47812566.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.