{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T15:04:15Z","timestamp":1790089455904,"version":"4.0.1"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2018,7,18]],"date-time":"2018-07-18T00:00:00Z","timestamp":1531872000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,2,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Murine typhus, or infection with Rickettsia typhi, is a global but neglected disease without randomized clinical trials to guide antibiotic therapy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A prospective, open, randomized trial was conducted in nonpregnant, consenting inpatient adults with rapid diagnostic test evidence of uncomplicated murine typhus at 2 hospitals in Vientiane, Laos. Patients were randomized to 7 days (D7) or 3 days (D3) of oral doxycycline or 3 days of oral azithromycin (A3). Primary outcome measures were fever clearance time and frequencies of treatment failure and relapse.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Between 2004 and 2009, the study enrolled 216 patients (72 per arm); 158 (73.2%) had serology\/polymerase chain reaction (PCR)\u2013confirmed murine typhus, and 52 (24.1%) were R. typhi PCR positive. The risk of treatment failure was greater for regimen A3 (22.5%; 16 of 71 patients) than for D3 (4.2%; 3 of 71) or D7 (1.4%; 1 of 71) (P &amp;lt; .001). Among R. typhi PCR\u2013positive patients, the area under the time-temperature curve and the fever clearance time were significantly higher for A3 than for D3 (1.8- and 1.9-fold higher, respectively; P = .005) and D7 (1.5- and 1.6-fold higher; P = .02). No patients returned with PCR-confirmed R. typhi relapse.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>In Lao adults, azithromycin is inferior to doxycycline as oral therapy for uncomplicated murine typhus. For doxycycline, 3- and 7-day regimens have similar efficacy. Azithromycin use in murine typhus should be reconsidered. Investigation of genomic and phenotypic markers of R. typhi azithromycin resistance is needed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical Trial Registration<\/jats:title>\n                  <jats:p>ISRCTN47812566.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciy563","type":"journal-article","created":{"date-parts":[[2018,7,7]],"date-time":"2018-07-07T08:50:15Z","timestamp":1530953415000},"page":"738-747","source":"Crossref","is-referenced-by-count":47,"title":["A Prospective, Open-label, Randomized Trial of Doxycycline Versus Azithromycin for the Treatment of Uncomplicated Murine Typhus"],"prefix":"10.1093","volume":"68","author":[{"given":"Paul N","family":"Newton","sequence":"first","affiliation":[{"name":"Lao-Oxford-Mahosot Hospital\u2013Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People\u2019s Democratic Republic"},{"name":"Centre for Tropical Medicine & Global Health, University of Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valy","family":"Keolouangkhot","sequence":"additional","affiliation":[{"name":"Adult Infectious Disease Ward, Mahosot Hospital, Vientiane, Lao People\u2019s Democratic Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sue J","family":"Lee","sequence":"additional","affiliation":[{"name":"Centre for Tropical Medicine & Global Health, University of Oxford, United Kingdom"},{"name":"Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khamla","family":"Choumlivong","sequence":"additional","affiliation":[{"name":"Setthathirat Hospital, Vientiane, Lao People\u2019s Democratic Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siho","family":"Sisouphone","sequence":"additional","affiliation":[{"name":"Adult Infectious Disease Ward, Mahosot Hospital, Vientiane, Lao People\u2019s Democratic Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khamloune","family":"Choumlivong","sequence":"additional","affiliation":[{"name":"Setthathirat Hospital, Vientiane, Lao People\u2019s Democratic Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manivanh","family":"Vongsouvath","sequence":"additional","affiliation":[{"name":"Lao-Oxford-Mahosot Hospital\u2013Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People\u2019s Democratic Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mayfong","family":"Mayxay","sequence":"additional","affiliation":[{"name":"Lao-Oxford-Mahosot Hospital\u2013Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People\u2019s Democratic Republic"},{"name":"Centre for Tropical Medicine & Global Health, University of Oxford, United Kingdom"},{"name":"Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao People\u2019s Democratic Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vilada","family":"Chansamouth","sequence":"additional","affiliation":[{"name":"Lao-Oxford-Mahosot Hospital\u2013Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People\u2019s Democratic Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viengmon","family":"Davong","sequence":"additional","affiliation":[{"name":"Lao-Oxford-Mahosot Hospital\u2013Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People\u2019s Democratic Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koukeo","family":"Phommasone","sequence":"additional","affiliation":[{"name":"Lao-Oxford-Mahosot Hospital\u2013Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People\u2019s Democratic 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