{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T09:29:26Z","timestamp":1772357366070,"version":"3.50.1"},"reference-count":0,"publisher":"Hematology Section, Dept. of Radiological Science and Hematology, Catholic University, Rome, Italy","issue":"1","license":[{"start":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T00:00:00Z","timestamp":1772236800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Mediterr J Hematol Infect Dis"],"abstract":"<jats:p>Background: Scrub typhus is a leading cause of febrile illness across the Asia\u2013Pacific region. Doxycycline is the first-line therapy, with azithromycin as an alternative, and sequential treatment (doxycycline followed by azithromycin) is used for non-responders. However, comparative real-world effectiveness for sequential therapy remains uncertain.\r\nMethods: We conducted a single\u2011center, non\u2011interventional target\u2011trial emulation at the 970th Hospital of the People\u2019s Liberation Army (January 2023 - June 2025). Consecutive patients \u226512 years receiving oral doxycycline, azithromycin, or sequential doxycycline\/azithromycin treatment were included. The primary outcome was 48\u2011hour defervescence sustained \u226524\u202fh without antipyretics. Secondary outcomes were time\u2011to\u2011defervescence, Day\u20115 failure, complications, length of stay, 28\u2011day mortality, and safety. Confounding was addressed with inverse\u2011probability weighting (generalized boosted models). The confirmatory comparison was doxycycline vs azithromycin in the non\u2011pregnant population to satisfy positivity. The sequential pathway was explored descriptively with time\u2011varying and 48\u2011hour landmark analyses.\r\nResults: We analyzed 512 patients (doxycycline 206; azithromycin 208; sequential 98). Crude 48\u2011hour defervescence was 82.0%, 78.8%, and 66.3%, respectively. In the confirmatory IPTW analysis, doxycycline vs azithromycin showed no difference (adjusted RR 1.03, 95% CI 0.95\u20131.12; p=0.34). Weighted time\u2011to\u2011event analysis was concordant (aHR 1.08, 95% CI 0.96\u20131.21; p=0.20). Secondary outcomes were similar between monotherapies (Day\u20115 failure aRR 0.83, 95% CI 0.56\u20131.24; complications aRR 0.94, 95% CI 0.66\u20131.33; median length of stay 5 [IQR 4\u20137] days in both; 28\u2011day mortality 1.6% overall). The sequential switch group had lower crude 48\u2011hour defervescence, consistent with escalation after early non\u2011response. Pairwise causal contrasts involving the sequential pathway were not presented due to structural bias.\r\nConclusions: Oral doxycycline and azithromycin demonstrated comparable effectiveness and safety for early defervescence in routine care. Inferior crude outcomes with sequential therapy likely reflect clinical escalation. Multi\u2011center validation and randomized trials are warranted.<\/jats:p>","DOI":"10.4084\/mjhid.2026.020","type":"journal-article","created":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T07:39:19Z","timestamp":1772350759000},"source":"Crossref","is-referenced-by-count":0,"title":["EVALUATION OF ORAL DOXYCYCLINE, AZITHROMYCIN, OR SEQUENTIAL DOXYCYCLINE-AZITHROMYCIN TREATMENT FOR SCRUB TYPHUS-"],"prefix":"10.4084","volume":"18","author":[{"given":"Hanchen","family":"Liu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Weizhen","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuqing","family":"Dong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2554","published-online":{"date-parts":[[2026,2,28]]},"container-title":["Mediterranean Journal of Hematology and Infectious Diseases"],"original-title":[],"link":[{"URL":"https:\/\/www.mjhid.org\/mjhid\/article\/download\/6173\/4830","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.mjhid.org\/mjhid\/article\/download\/6173\/4831","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.mjhid.org\/mjhid\/article\/download\/6173\/4830","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T07:39:20Z","timestamp":1772350760000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mjhid.org\/mjhid\/article\/view\/6173"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,28]]},"references-count":0,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,1]]}},"URL":"https:\/\/doi.org\/10.4084\/mjhid.2026.020","relation":{},"ISSN":["2035-3006"],"issn-type":[{"value":"2035-3006","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,28]]}}}