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, 1,2 but there are few successful case reports of treatment. 3 We 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 immunoassays 4 on 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