Rickettsia Clearance Study

Inclusion Criteria: * Age above or equal 18 years * Able to take oral medication * Rapid test positive for murine typhus or scrub typhus * Agrees to stay in hospital for at least 36 hours and to attend for scheduled follow up visits * Written informed consent to participate in the study * A negative urinary pregnancy test for all women of child-bearing age Exclusion Criteria: * Pregnancy or breast feeding * Previous allergic reaction to doxycycline or azithromycin * Received more than one dose of chloramphenicol, doxycycline, tetracycline, fluoroquinolones, rifampicin or azithromycin during this hospital admission or more than one dose of any of these drugs in the week before admission * Contraindication to doxycycline: severe hepatic impairment, known SLE * Contraindication to azithromycin: sever hepatic impairment * Severe typhus defined as the presence of one or more of the following: 1. Reduced level of consciousness 2. Clinical jaundice 3. Shock (BP systolic \<80 mmHg) 4. Unable to take oral medication 5. Radiological evidence of pneumonia 6. Clinical evidence for meningitis/encephalitis or the need of LP 7. Alternative diagnosis confirmed that explains the presenting symptoms 8. Any other syndrome which in the opinion of the admitting doctor constitutes severe typhus (reason must be stated)