A 28-year-old soldier returns from a forested area of northeastern India with high fever, headache, myalgia and an eschar over his ankle. Scrub typhus (Orientia tsutsugamushi) is suspected. The standard recommended treatment is:
- A Ceftriaxone for 7 days
- B Doxycycline 200 mg daily for 5 to 7 days ✓
- C Metronidazole for 10 days
- D Gentamicin until defervescence
Correct answer: B. Doxycycline 200 mg daily for 5 to 7 days
Explanation
Rickettsial and Orientia species are obligate intracellular organisms classically treated with doxycycline, which penetrates host cells effectively; short-course doxycycline is the accepted standard for scrub typhus in endemic regions. Azithromycin and rifampicin are alternatives in pregnancy or doxycycline intolerance. Ceftriaxone and gentamicin have no activity against intracellular rickettsiae, and Orientia lacks the anaerobic metabolism needed to activate metronidazole.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.