A 26-year-old woman at 14 weeks of gestation from Uttarakhand presents with 5 days of fever, an eschar over the axilla, and generalised lymphadenopathy. Scrub typhus is confirmed by IgM ELISA. Which is the most appropriate therapy?
- A Doxycycline 100 mg twice daily for 7 days
- B Azithromycin 500 mg once daily for 5 days ✓
- C Chloramphenicol 500 mg four times daily
- D Ceftriaxone 2 g once daily
Correct answer: B. Azithromycin 500 mg once daily for 5 days
Explanation
Doxycycline is the drug of choice for scrub typhus in non-pregnant patients, but tetracyclines are contraindicated in pregnancy because they discolour developing teeth and affect fetal bone. Azithromycin is the recommended alternative in pregnancy and is also preferred where doxycycline-resistant strains occur, such as northern Thailand. Chloramphenicol is a second-line alternative but carries aplastic anaemia risk and is avoided in late pregnancy. Cephalosporins have no activity against Orientia.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.