Dawaa Reference

infectious

Endemic Flea-Borne and Tick-Borne Typhus

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources4 sources

CDC Yellow Book 2024: Rickettsial Infections · CDC Yellow Book 2026: Rickettsial Diseases (NCBI Bookshelf NBK620978), Treatment · Egyptian National Drug Formulary (Antimicrobial Chapter 2023) · Egyptian National Drug Formulary - Antimicrobial 2023 (chloramphenicol monograph)

Verified against2 documents
  • Egyptian National Drug Formulary - Antimicrobial 2023
  • CDC Yellow Book 2026: Rickettsial Diseases (NCBI Bookshelf NBK620978), Treatment

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Red flags (2)

  • Start treatment as soon as rickettsial disease is suspected; never withhold it pending confirmatory testing, because some infections progress rapidly
  • Rocky Mountain spotted fever, scrub typhus, Mediterranean spotted fever, murine typhus and epidemic typhus can all be life-threatening if antibiotics are delayed

Symptoms — what the patient reports (6)

  • Murine typhus usually presents as a moderately severe but otherwise non-specific febrile illness [fever]
  • About half develop a maculopapular rash, generally appearing on the trunk [rash]
  • Untreated, the fever can persist for up to 2 weeks [fever]
  • The classic rickettsial triad is fever, headache and rash, but these are variably present and the triad is not a reliable way to diagnose [fever · headache · rash]
  • Symptoms common across rickettsial infections are fever, headache, malaise, rash, nausea or vomiting, typically within 1 week of infection [fever · headache · malaise · nausea · rash · vomiting]
  • Incubation for most rickettsial disease is 5 to 10 days, so a traveller falls ill during the trip or within 1 to 2 weeks of getting home

Signs — what you find (2)

  • Many rickettsioses show a maculopapular, vesicular or petechial rash, or a dark necrotic eschar at the bite site - but murine typhus is not an eschar disease [blisters · necrosis · petechiae · rash · vesicles]
  • Organ failure can develop and death does occur, though it is generally less severe than Rocky Mountain spotted fever or scrub typhus [fever]

Tests (4)

  • Serology confirms retrospectively: a 4-fold or greater rise in indirect immunofluorescence antibody titre between paired sera taken 2 to 4 weeks apart
  • Cross-reacting antigens may limit serology to the group or genus rather than the species
  • PCR of a whole blood specimen is usually positive only once the disease has advanced and the patient is severely ill
  • Where an eschar is present, PCR on an eschar swab or biopsy is sensitive and species-specific

If not this — what else fits (5)

  • Rickettsia typhi is flea-borne, found worldwide but especially around urban port cities and coastal areas with large rodent populations
  • Ask about flea-infested cats, dogs or peridomestic rodents; murine typhus is reported in travellers returning from Asia, Africa and the Mediterranean Basin
  • Other rickettsioses to weigh: African tick bite fever, Mediterranean spotted fever, scrub typhus, Rocky Mountain spotted fever, epidemic (louse-borne) typhus, rickettsialpox, ehrlichiosis and anaplasmosis
  • Cytopenias, particularly leukopenia and thrombocytopenia, point towards ehrlichiosis or anaplasmosis rather than typhus
  • Early rickettsial illness looks like other tropical diseases sharing the same geography and season

SourceCDC Yellow Book 2026 "Rickettsial Diseases" (NBK620978) - the rickettsial chapter; endemic (murine, flea-borne) typhus is Rickettsia typhi within it, and this card is scoped to that plus the shared rickettsial features

Presentation findings are traced to the source above.

1

DOXYCYCLINE

1st line

Strength100 mg

Formoral.solid

Adult dose and duration

100 mg orally twice daily - At least 5 to 7 days

Paediatric dose

2.2 mg/kg/dose

(Children < 45 kg: 2.2 mg/kg per dose orally twice daily. Children >= 45 kg: 100 mg orally twice daily. Doxycycline is first-line for rickettsial infections in children of any age.)

Dose by weight
3kg6.6 mg/dose
4kg8.8 mg/dose
5kg11 mg/dose
6kg13.2 mg/dose
7kg15.4 mg/dose
8kg17.6 mg/dose
9kg19.8 mg/dose
10kg22 mg/dose
11kg24.2 mg/dose
12kg26.4 mg/dose
13kg28.6 mg/dose
14kg30.8 mg/dose
15kg33 mg/dose
16kg35.2 mg/dose
17kg37.4 mg/dose
18kg39.6 mg/dose
19kg41.8 mg/dose
20kg44 mg/dose
21kg46.2 mg/dose
22kg48.4 mg/dose
23kg50.6 mg/dose
24kg52.8 mg/dose
25kg55 mg/dose
26kg57.2 mg/dose
27kg59.4 mg/dose
28kg61.6 mg/dose
29kg63.8 mg/dose
30kg66 mg/dose
31kg68.2 mg/dose
32kg70.4 mg/dose
33kg72.6 mg/dose
34kg74.8 mg/dose
35kg77 mg/dose
36kg79.2 mg/dose
37kg81.4 mg/dose
38kg83.6 mg/dose
39kg85.8 mg/dose
40kg88 mg/dose
41kg90.2 mg/dose
42kg92.4 mg/dose
43kg94.6 mg/dose
44kg96.8 mg/dose
45kg99 mg/dose
46kg101.2 mg/dose
47kg103.4 mg/dose
48kg105.6 mg/dose
49kg107.8 mg/dose
50kg110 mg/dose
Dose source

Egyptian National Drug Formulary - Antimicrobial 2023 (doxycycline monograph): adult "Usual dosage range: Oral: IR and most ER formulations: 100 to 200 mg/day in 1 to 2 divided doses" with 100 mg capsules, and paediatric "Children and Adolescents: Oral, IV: 2.2 mg/kg/dose every 12 hours, maximum dose: 100 mg/dose". The rickettsial indication and the course length are from the CDC Yellow Book 2026 rickettsial diseases chapter (NCBI Bookshelf NBK620978), now on disk, which states: "Doxycycline is the treatment of choice for all rickettsial infections (100 mg by mouth twice daily for a minimum of 5-7 days; or 2.2 mg/kg by mouth twice daily for children <45 kg)".

Why

Doxycycline is the definitive drug of choice for all rickettsial infections (murine typhus and tick-borne typhus) across all age groups, as short courses (< 14 days) do not cause dental staining.

Cautions
  • In pregnancy the Yellow Book names chloramphenicol rather than azithromycin. In breastfeeding, the Egyptian formulary says a short doxycycline course is probably not harmful - so it is not an absolute bar.
  • Initiate treatment immediately upon clinical suspicion of rickettsial typhus; delaying doxycycline therapy increases risk of severe organ dysfunction and mortality.
  • Administer with food and plenty of water in an upright position to prevent esophageal irritation and ulceration.
  • Advise patients to avoid direct sun exposure due to photosensitivity risk.
Egyptian brands
Egyptian brandManufacturerIndicative price
FARCODOXIN 100MG 10 CAPS.PHARCO11.00 EGP (1.10/unit)
DOXY M.R.100 MG 10 CAPS.ADWIA12.00 EGP (1.20/unit)
GRANUDOXY 100MG 10 F.C. TAB.GLOBAL NAPI PHARMACEUTICALS > PIERRE FRANCE12.00 EGP (1.20/unit)
DOXYDOX 100 MG 10 CAPS.EIPICO23.00 EGP (2.30/unit)
DOXYMYCIN 100 MG 10 CAPS.EL NILE.30.00 EGP (3.00/unit)
TABOCINE 100MG 10 CAPS.TABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA46.00 EGP (4.60/unit)
VIBRAMYCIN 100MG 10 CAPS.PFIZER65.00 EGP (6.50/unit)

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.