Expert: Tina Budde - 10/3/2009

Question
QUESTION: My wife was diagnosed with typhus and has been taking docycycline for 6 days so far.  She has shown little improvement.  How long should it be before we see improvement on the docycycline?
Thanks

ANSWER: Hi Dacus,

It would depend on the type of typhus she has what treatment would be appropriate, whether it's epidemic from a tick or mite, etc.

There are also complications to consider and sometimes the complications are worse than the condition that causes them.  Fatigue is a major symptom.  Usually antibiotics are the first course of treatment, some require hospitalization, if she isn't better after a few more days, you need to call the doctor so he can examine her and do some tests to make sure her labs are in order.  Usually when antibiotics are prescribed, they start to work on the 4th and 5th days, as the medicine builds up enough strength to kill off bacteria.  In my opinion, I have always felt a 7 day course is not enough for major infections, a 10 day would be better and myself, I would insist on a 14 course to be sure I don't have a relapse.  All doctors have different ideas on this but it's something to keep in mind.  For severe infections longer courses than the 14 days are necessary especially in diabetic patients or the immune-depressed.

Tina

---------- FOLLOW-UP ----------

QUESTION: Thanks,Tina,
    She has been taking the Docycycline for about 8 days now, she has a 21 day prescription.  She still has a fever of about 102, cold chills and hot spells, these seem to be getting better, headache, fatigue, and joint and muscle pain.  She can't stand for more than a few minutes before her legs start to hurt really bad.  She takes loratab, 1-2 every eight hours, and the fever and chills get better on the loratab, but the aches in her joints and muscles seem to be getting worse daily.  
She found a tick on her Aug 19, and she got sick on Sept 9th.  Since then she has not been out of the house except to go to the doctor.  She spends 95% of her time in bed.  The CDC in Atlanta says the she got typhus (Murine, Endemic) from a flea bite.  That is possible because up until the middle of Aug we were feeding some outside, feral, cats.  We have stopped and they don't come around anymore.  We have inside cats and they do not have fleas.  
  My wife is from South Korea and she has been in the US since 1976.  The doctor said that this is a new case and not a typhus relapse.  
   She took amoxicillan from Sept 5 until she started the docycycline on the night of Sept 23.
    How long should we have to wait to see results from the Docycycline, and if no results, then what.

Thanks again for all your help.  

Answer
Hi Dacus,

The problem is that some antibiotics work well on some people but not others, the first one she took the amoxillian used to be a really good antibiotic but it has been abused by people taking it for colds which are virus, and didn't need it.  When it's taken alot and not needed the bacteria become immune to it.  The docycline is a good antibiotic but it may not again be the one that works on her.  It's 8 days out of a 3 week prescription, I would say in another 4 days if she's not feeling better, you need to go back to the doctor and be referred to an infectious disease specialist.  It may need to be she is on an a different antibiotic, rest is definitely indicated and many people with typhus wind up in the hospital so I'm surprized she is not hospitalized.  

tina