Fluoroquinolones versus doxycycline in the treatment of rickettsial infection: A Tunisian multicenter prospective study

Abstract

Introduction: Doxycycline is considered as the standard treatment of rickettsiosis. Fluoroquinolones used as an alternative therapy, until recent studies have shown that Fluoroquinolones are associated with a deleterious outcome.
Objectives: To compare therapeutic efficacy and safety of fluoroquinolones and doxycycline in the treatment of Rickettsiosis
Methods: we conducted an open-label randomized controlled multicenter study. This study aim to compare the efficacy and safety of oral ciprofloxacin (1000 mg/day) or ofloxacin (400mp/day) in 2 doses with those of oral doxycycline (200mg/day) once daily for 3 to 10 days, according
to the severity of illness, in the treatment of Rickettsioses, We included patients more than 15 year-old who presented the characteristic clinical triad (eschar + rash + fever) and/or microbiological confirmation (positive serology and/or positive qPCR).
Results: Among 112 enrolled patients, 82 retained. Thirty-four patients received fluoroquinolones and 48 received doxycycline. Patients in both groups were comparable with respect to age. Two severe cases were noted with fluoroquinolones (meningitis = one, encephalitis= 1) and three with doxycycline (myocarditis=one, severe sepsis = l and encephalitis =1) .|The defervescence period was 2.6 + 1.04 days in the doxycycline
group and2.31.09 days in the fluoroquinolones group (p20.05). All patients recovered. One patient treated by doxycycline had a digital necrosis, generating amputation.
Conclusions: Both fluoroquinolones and doxycycline were effective for treating patients with rickettsia infections. Even that doxycycline remains the standard of treatment, with the advantage of a single daily dose; fluoroquinolones are an interesting alternative with no deleterious outcome.