**2.5. Treatment**

Doxycycline is the drug of choice. It is bacteriostatic to *O. tsutsugamushi* but does not cross the blood brain barrier beyond 15–30% [2]. Therefore, in some instances, neurological deterioration can continue despite doxycycline therapy. This may be due to resistance, immune-mediated injury, or due to drug interactions with oral antacids. Doxycycline is given in the dose of 200 mg/day, in two divided doses, for individuals above 45 kgs body weight, for a duration of 7 days. In children, doxycycline is given in the dose of 4.5 mg/kg body weight in two divided doses. Doxycycline is contraindicated in pregnant women. In complicated cases, intravenous is given followed by oral doxycycline to complete 7–15 days of therapy.

Azithromycin is another drug which can be used in a dose of 500 mg daily for 5 days and 10 mg/kg body weight in children for 5 days. It can also be given intravenously in complicated cases. Azithromycin is the drug of choice in pregnant women with scrub typhus. It is also preferred in patients of scrub typhus with renal failure, where doxycycline is not given.

In complicated cases, Chloramphenicol can also be used. It is administered intravenously at a dose of 50–100 mg/kg/day, 6 hourly doses, followed by oral therapy to complete 7–15 days of therapy.

Doxycycline and/or chloramphenicol resistant strains have been detected in South-East Asia. These strains are sensitive to Azithromycin.

Patients with meningoencephalitis due to scrub typhus can be additionally administered with dexamethasone, or mannitol, if they have altered sensorium or cranial nerve deficits.

Recovery is usually brisk with appropriate therapy.

Pre-antibiotic era mortality was more than 60%; however, recent data show a mortality of approximately 30% [2]. In the author's study [6], the mortality was 15.38%. Mortality is usually associated with multi-organ dysfunction syndrome.
