Scrub Typhus, a zoonotic bacterial infection presents as an acute febrile illness if untreated and can reach severe disease in 70% of patients.   

Severe disease can lead to prolonged hospitalization and even lead death due to multiorgan dysfunction and shock.  

A Randomized Controlled Intravenous Treatment for Scrub Typhus (INTREST)Trial done across seven sites in India revealed that combination therapy is superior to monotherapy with IV doxycycline or azithromycin.   

In the trial, patients with severe disease received in-hospital, 7-days, IV Doxycycline (200 mg BD on day 1, then 100 mg BD), and Azithromycin (500 mg BD on day 1, then 500 mg OD) as a combination therapy.  

The incidence of complications of scrub typhus and composite primary outcome event (persistent complications by day 7) is better i.e., lesser in combination therapy. 

Faster bacterial clearance is achieved in both azithromycin and combination therapy.

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