Ciprofloxacin Treatment of Typhus

To the Editor. — Ciprofloxacin is a quinolone antibiotic that is effective against a variety of bacterial pathogens. In vitro activity against Rickettsiaceae has been documented,1,2but there are few successful case reports of treatment.3We present two cases of rickettsial disease in which fever and constitutional symptoms resolved within 72 hours of starting ciprofloxacin therapy. These diagnoses were established by indirect immunoperoxidase antirickettsial immunoassays4on paired serum samples performed at the Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand. Report of Cases.— Case 1.— A 33-year-old Dutch man working in Nepal presented with 6 days of fever (temperature as high as 39.5°C), severe headaches, and myalgias. Ten days before the onset of symptoms he stayed with a Nepalese family and sustained multiple bites from insects in their straw mattress. His temperature was 38.6°C, his pulse rate was 104 beats per minute, and his blood