DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20150370

A clinical trial of treatment of uncomplicated typhoid fever: efficacy of ceftriaxone-azithromycin combination

Vishal P. Giri, Om P. Giri, Anshuman Srivastava, Chandan Mishra, Ajay Kumar, Shubhra Kanodia

Abstract


Background: Typhoid fever is a systemic infection caused by Gram-negative bacterium Salmonella enterica serovar typhi (S. typhi). It is a major health problem in India. It carries significant morbidity and mortality. Antimicrobial therapy is critical for the management of typhoid fever. Emergence of multidrug-resistant (MDR) and nalidixic acid-resistant (NAR) strains of S. typhi has complicated therapy by limiting treatment options. Hence, this study was conducted to evaluate the efficacy and safety profile of ceftriaxone and azithromycin combination therapy in uncomplicated typhoid fever.

Methods: Adults patients of blood culture proven uncomplicated typhoid fever admitted in the medicine ward of Teerthanker Mahaveer Medical College and Research Centre were treated with ceftriaxone intravenously (2 g daily for 14 days) and azithromycin orally (500 mg daily for 7 days). Patients were clinically and bacteriologically evaluated during the study period and follow-up.

Results: 96% cure rate was observed. No relapse was recorded.

Conclusion: Ceftriaxone-azithromycin combination may be considered as an empirical therapy for treatment of uncomplicated typhoid fever in view of the emergence of MDR and NAR strains of S. typhi.


Keywords


Typhoid fever, Ceftriaxone, Azithromycin

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References


Available at http://www.cdc.gov/travel/yellowbook/2014/chapter3-infectious- diseases- related travel/typhoid and paratyphoid fever. Accessed 04 January 2015.

Singhal L, Gupta PK, Kale P, Gautam V, Ray P. Trends in antimicrobial susceptibility of Salmonella typhi from North India (2001-2012). Indian J Med Microbiol 2014;32(2):149-52.

Geetha VK, Yugendran T, Srinivasan R, Harish BN. Plasmid-mediated quinolone resistance in typhoidal Salmonellae: a preliminary report from South India. Indian J Med Microbiol. 2014;32(1):31-4.

Gokul BN, Menezes GA, Harish BN. ACC-1 beta-Lactamase-producing Salmonella enterica Serovar Typhi, India. Emerg Infect Dis. 2010;16(7):1170-1.

Trivedi NA, Shah PC. A meta-analysis comparing the safety and efficacy of azithromycin over the alternate drugs used for treatment of uncomplicated enteric fever. J Postgrad Med. 2012;58(2):112-8.

Rai S, Jain S, Prasad KN, Ghoshal U, Dhole TN. Rationale of azithromycin prescribing practices for enteric fever in India. Indian J Med Microbiol. 2012;30(1):30-3.

Pegues DA, Miller SI. Salmonella species, including Salmonella typhi. In: Mandell GL, Bennett IE, Dolon R, editors. Mandell, Douglas and Benetts’s Principle and Practice of Infectious Diseases. 7th Edition. Philadelphia: Elsevier Churchill Livingstone; 2010: 2887-993.

Shetty AK, Shetty IN, Furtado ZV, Antony B, Boloor R. Antibiogram of Salmonella isolates from blood with an emphasis on nalidixic acid and chloramphenicol susceptibility in a tertiary care hospital in coastal Karnataka: a prospective study. J Lab Physicians. 2012;4(2):74-7.

Pontali E, Feasi M, Usiglio D, Mori M, Cassola G. Imported typhoid fever with hepatitis from Bangladesh: a case of delayed response to ceftriaxone? J Travel Med. 2008;15(5):366-8.

Garg A, Verma S, Kanga A, Singh D, Singh B. Antimicrobial resistance pattern and in-vitro activity of azithromycin in Salmonella isolates [corrected]. Indian J Med Microbiol. 2013;31(3):287-9.

Jain S, Das Chugh T. Antimicrobial resistance among blood culture isolates of Salmonella enterica in New Delhi. J Infect Dev Ctries. 2013;7(11):788-95.

Molloy A, Nair S, Cooke FJ, Wain J, Farrington M, Lehner PJ, et al. First report of Salmonella enterica serotype paratyphi A azithromycin resistance leading to treatment failure. J Clin Microbiol. 2010;48(12):4655-7.

Schwartz E. Typhoid and paratyphoid fever. In: Schwartz E, editor. Tropical Diseases in Travelers. New York, NY: John Wiley & Sons; 2009: 144-153.

Butler T. Treatment of typhoid fever in the 21st century: promises and shortcomings. Clin Microbiol Infect. 2011;17(7):959-63.

Sjölund-Karlsson M, Joyce K, Blickenstaff K, Ball T, Haro J, Medalla FM, et al. Antimicrobial susceptibility to azithromycin among Salmonella enterica isolates from the United States. Antimicrob Agents Chemother. 2011;55(9):3985-9.

Meltzer E, Stienlauf S, Leshem E, Sidi Y, Schwartz E. A large outbreak of Salmonella Paratyphi A infection among Israeli travelers to Nepal. Clin Infect Dis. 2014;58(3):359-64.