A 24-year-old pregnant woman at 20 weeks gestation presents with 5 days of fever, severe headache, and an eschar on her thigh. She works on a farm in Uttarakhand. Serology confirms Orientia tsutsugamushi infection. Which drug is the most appropriate choice for this patient?
- A Azithromycin ✓
- B Doxycycline
- C Chloramphenicol
- D Ciprofloxacin
Correct answer: A. Azithromycin
Explanation
Doxycycline is the drug of choice for scrub typhus in general, but tetracyclines are contraindicated in pregnancy because they inhibit bone growth and discolour developing teeth. Azithromycin has documented efficacy against Orientia tsutsugamushi and is the recommended alternative in pregnant women and in doxycycline-resistant strains seen in parts of Southeast Asia. Chloramphenicol carries a risk of grey baby syndrome and aplastic anaemia, so it is avoided when a safer oral agent exists.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.