{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T20:12:44Z","timestamp":1780344764863,"version":"3.54.1"},"reference-count":48,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2019,10,1]],"date-time":"2019-10-01T00:00:00Z","timestamp":1569888000000},"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":[[2020,5,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Scrub typhus, a neglected infectious disease caused by the obligate intracellular bacterium Orientia tsutsugamushi, is a major cause of fever across the Asia Pacific region with more than a billion people at risk. Treatment with antibiotics such as doxycycline or chloramphenicol is effective for the majority of patients. In the 1990s, reports from northern Thailand raised a troubling observation; some scrub typhus patients responded poorly to doxycycline, which investigators attributed to doxycycline resistance. Despite the controversial nature of these reports, independent verification was neglected, with subsequent studies speculating on the role of doxycycline resistance in contributing to failure of treatment or prophylaxis. In this review, we have outlined the evidence for drug-resistant Orientia tsutsugamushi, assessed the evidence for doxycycline resistance, and highlight more recent findings unsupportive of doxycycline resistance. We conclude that doxycycline resistance is a misconception, with treatment outcome likely to be determined by other bacterial, host, and pharmacological factors.<\/jats:p>","DOI":"10.1093\/cid\/ciz972","type":"journal-article","created":{"date-parts":[[2019,9,28]],"date-time":"2019-09-28T04:00:11Z","timestamp":1569643211000},"page":"2444-2449","source":"Crossref","is-referenced-by-count":37,"title":["Scrub Typhus and the Misconception of Doxycycline Resistance"],"prefix":"10.1093","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0430-5699","authenticated-orcid":false,"given":"Tri","family":"Wangrangsimakul","sequence":"first","affiliation":[{"name":"Mahidol -Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand"},{"name":"Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weerawat","family":"Phuklia","sequence":"first","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":"Paul N","family":"Newton","sequence":"first","affiliation":[{"name":"Mahidol -Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand"},{"name":"Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom"},{"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":"Allen L","family":"Richards","sequence":"first","affiliation":[{"name":"Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas P J","family":"Day","sequence":"first","affiliation":[{"name":"Mahidol -Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand"},{"name":"Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,10,1]]},"reference":[{"key":"2020052309501912500_CIT0001","doi-asserted-by":"crossref","first-page":"e0003971","DOI":"10.1371\/journal.pntd.0003971","article-title":"A systematic review of mortality from untreated scrub typhus (Orientia tsutsugamushi)","volume":"9","author":"Taylor","year":"2015","journal-title":"PLoS Negl Trop Dis"},{"key":"2020052309501912500_CIT0002","doi-asserted-by":"crossref","first-page":"e0005838","DOI":"10.1371\/journal.pntd.0005838","article-title":"Estimating the burden of scrub typhus: a systematic review","volume":"11","author":"Bonell","year":"2017","journal-title":"PLoS Negl Trop Dis"},{"key":"2020052309501912500_CIT0003","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1126\/science.108.2798.160","article-title":"Chloromycetin in the treatment of scrub typhus","volume":"108","author":"Smadel","year":"1948","journal-title":"Science"},{"key":"2020052309501912500_CIT0004","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/S0169-4758(97)01020-X","article-title":"Drug-resistant scrub typhus: paradigm and paradox","volume":"13","author":"Rosenberg","year":"1997","journal-title":"Parasitol Today"},{"key":"2020052309501912500_CIT0005","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1001\/archinte.1973.03650070069010","article-title":"Scrub typhus. 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