Re-evaluating Presumptive Treatment with Doxycycline/ Azithromycin in Children With Acute Febrile Illness in a Scrub Typhus Endemic Region: A Cross-Sectional Study.

Objective: To estimate the proportion of children with acute febrile illness (AFI) attending the peripheral health facilities in Gorakhpur, Uttar Pradesh, India, due to Orientia tsutsugamushi (Ots) and re-evaluate the strategy of presumptive administration of doxycycline/azithromycin (PDA) to patients with AFI.

Methods: Children aged 2-18 years with AFI attending 16 peripheral health facilities in Gorakhpur, Uttar Pradesh, were enrolled in September 2023. Blood samples were tested for O. tsutsugamushi using serological and molecular methods, and antibiotics prescribed were recorded.

Results: Of the 345 patients, 40 (11.6 %) tested positive for scrub typhus. 290 children were prescribed antibiotics, either alone or in combination; Azithromycin was prescribed to 66.5%, doxycycline to 5.5% and both antibiotics to 7.2%. None of the AFI patients progressed to acute encephalitis syndrome.

Conclusion: About one in ten AFI patients in Gorakhpur showed evidence of Ots infection during the peak AES season. With the availability of scrub typhus testing facilities in the district, the PDA strategy may be revised to treatment based on laboratory confirmation with focus on strengthening the existing hub-and-spoke model.