Azithromycin for treating uncomplicated typhoid and paratyphoid fever (enteric fever)

Effa, Emmanuel; Bukirwa, Hasifa

doi:10.1002/14651858.cd006083.pub2

Cited by 64 publications

(26 citation statements)

References 57 publications

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“…Azithromycin is safe and efficacious for the treatment of uncomplicated typhoid [25, 26]. Although there are no current clinical MIC breakpoints, the majority of isolates (88%) here were susceptible, using the previously suggested cutoff of <16 µg/mL [27].…”

Section: Discussionmentioning

confidence: 99%

Treatment Response in Enteric Fever in an Era of Increasing Antimicrobial Resistance: An Individual Patient Data Analysis of 2092 Participants Enrolled into 4 Randomized, Controlled Trials in Nepal

Thompson

Karkey

Dongol

et al. 2017

Clinical Infectious Diseases

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Section: Discussionmentioning

confidence: 99%

Treatment Response in Enteric Fever in an Era of Increasing Antimicrobial Resistance: An Individual Patient Data Analysis of 2092 Participants Enrolled into 4 Randomized, Controlled Trials in Nepal

Thompson

Karkey

Dongol

et al. 2017

Clinical Infectious Diseases

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“…8,15,16 Azithromycin is now regarded as the drug of choice for the treatment of Asian-acquired, uncomplicated enteric fever, with ceftriaxone as an alternative in those with complicated disease, or where there are concerns over gastrointestinal absorption. 27 Reduced ciprofloxacin sensitivity is less common in other geographical regions such as Africa, 28 but is likely to become increasingly common. Treatment of enteric fever should be guided by microbiology laboratory data, and empiric antimicrobial therapy in suspected cases should reflect the trends in antimicrobial resistance in endemic regions…”

Section: Discussionmentioning

confidence: 99%

Enteric fever in a UK regional infectious diseases unit: A 10 year retrospective review

Clark

Daneshvar

Pareek

et al. 2010

Journal of Infection

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“…Azithromycin has been used in the treatment of infections with S. Typhi and some enteric infections, and the accepted BSAC breakpoint MIC is 16 mg/liter for wild-type isolates. Azithromycin is suggested as an alternative to ciprofloxacin for treatment of cases that show reduced susceptibility to fluoroquinolones or treatment failure (2,8,9,18). Chayani et al recently showed that azithromycin was active against Salmonella and Shigella species, showing 100% sensitivity by the Etest and 83.33% by the disk diffusion methods (6).…”

Section: Case Reportmentioning

confidence: 99%

First Report of Salmonella enterica Serotype Paratyphi A Azithromycin Resistance Leading to Treatment Failure

Molloy

Nair²,

Cooke

et al. 2010

J Clin Microbiol

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The prevalence of Salmonella enterica serotype Paratyphi A infection is increasing, and multidrug resistance is a well-recognized problem. Resistance to fluoroquinolones is common and leads to more frequent use of newer agents like azithromycin. We report the first case of azithromycin resistance and treatment failure in a patient with S. Paratyphi A infection. CASE REPORTA 48-year-old male doctor presented to the accident and emergency department with a 2-week history of rigors, fever, and lethargy following a 10-day vacation in Islamabad, Pakistan. He had not been vaccinated against typhoid or taken antimalarial chemoprophylaxis. He developed diarrhea 2 days prior to the end of his stay in Pakistan and took oral metronidazole at 400 mg three times daily for 5 days. The diarrhea resolved, but his temperature continued to spike to 39°C over the following 2 weeks. He had a prior medical history of hypercholesterolemia and gout and had had an appendectomy as a young student. His regular medications consisted of allopurinol at 200 mg once daily and simvastatin at 20 mg once daily. Clinical examination on presentation was unremarkable other than a temperature of 38.5°C.Initial laboratory investigations revealed a raised alanine transaminase (ALT) level of 93 IU/liter (normal value, 10 to 50 IU/liter), a bilirubin level of 20 mol/liter (normal value, 3 to 17 mol/liter), and a C-reactive protein (CRP) level of 70 mg/liter (normal value, Ͻ5 mg/liter). Full blood count, serum electrolytes, and creatinine were within normal limits. Chest and abdominal radiographs showed no abnormalities. A malaria blood film and antigen test were negative.In view of the possibility of enteric fever, he was started on oral ciprofloxacin at 500 mg twice daily according to the hospital antibiotic policy. He was reluctant to be admitted to the hospital and was discharged with a follow-up appointment in the infectious diseases outpatient clinic. Blood cultures taken on admission yielded Salmonella enterica serotype Paratyphi A, which was reported as sensitive to ciprofloxacin on disc testing.The patient presented again following 7 days of treatment with persistent fever and rigors. He remained reluctant to be admitted, and so antimicrobial therapy was changed to oral azithromycin.His symptoms worsened over the next 3 days, and he was admitted to the hospital. He complained of increasing frequency of rigors and fevers, occurring every 4 h and lasting for 2 h, and a dry cough. He had been fully adherent to the antimicrobial therapy prescribed. On examination he had a temperature of 38°C and the spleen was palpable 1 cm below the costal margin. In view of the poor response to treatment, antimicrobial therapy was changed to intravenous ceftriaxone at 2 g once daily.Laboratory investigations revealed a raised CRP level of 65 mg/liter (normal value, Ͻ5 mg/liter), an ALT level of 358 IU/liter (normal value, 10 to 50 IU/liter), an alkaline phosphatase level of 256 IU/liter (normal value, 30 to 200 IU/liter), and a negative malaria film. A repeat ches...

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Azithromycin for treating uncomplicated typhoid and paratyphoid fever (enteric fever)

Cited by 64 publications

References 57 publications

Treatment Response in Enteric Fever in an Era of Increasing Antimicrobial Resistance: An Individual Patient Data Analysis of 2092 Participants Enrolled into 4 Randomized, Controlled Trials in Nepal

Treatment Response in Enteric Fever in an Era of Increasing Antimicrobial Resistance: An Individual Patient Data Analysis of 2092 Participants Enrolled into 4 Randomized, Controlled Trials in Nepal

Enteric fever in a UK regional infectious diseases unit: A 10 year retrospective review

First Report of Salmonella enterica Serotype Paratyphi A Azithromycin Resistance Leading to Treatment Failure

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