Antibiotic Antagonism in Orientia tsutsugamushi Infection: A Narrative Review

study demonstrated that cefotaxime reduces the effects of anti-rickettsial antibiotics, including doxycycline, by at least 25%. This potential antibiotic antagonism may delay fever resolution by 1-5 days, a minor difference often difficult to detect in individual patients. Even when detected, it is frequently misinterpreted as antibiotic resistance or attributed to severe disease or atypical clinical manifestations. Furthermore, this phenomenon may contribute to mortality in cases with life-threatening complications.