Azithromycin Versus Ceftriaxone- Which Is Better in Uncomplicated Typhoid Fever? A Clinical Trial in a Tertiary Care Hospital

Abstract

BACKGROUND Enteric fever has been very a common and many times a fatal infective disease found in developing countries and has been known to have increasing resistance to novel drugs. So, there is an urgent need for a simple, therapeutic, cost-effective medicine to treat typhoid fever & to prevent further drug resistance. METHODS It is a non-randomized, case-control study done in Paediatrics department of Dr. Prabhakar Kore Hospital & Research centre of KAHER (KLE Academy of Higher Education and Research), attached to J N Medical College, Belagavi, over a period of 18 months from June 2017 to December 2018. The study included 200 children (2-17 years of age) with positive Widal result, uncomplicatedenteric fever; in this cohort, 100 children were treated using (oral, low dose, for short duration of 6 days) Azithromycin and remaining 100 children were treated with (intravenous, 7 days) Ceftriaxone. Each child was assessed clinically every day, & study results were captured as clinical and microbiological cure or failure, at the end of either drug regimens. This descriptive data was statistically analysed in SPSS-20.0 software. The p-value of <0.05 was taken as significant statistically. RESULTS Periods required by children for responding to drug therapy and to became afebrile i.e., defervescence were significantly (p=0.000) less with Azithromycin receiving group than ceftriaxone receiving group. 95% of children who received azithromycin showed defervescence by 5 th day of regimen but, only 29% of children receiving ceftriaxone attained defervescence by 5 th day of regimen. There was no microbiological clearance at 10 th day in only one case of ceftriaxone trial-group. Significantly (p=0.027) there was early clinical cure in azithromycin trial group as compared to ceftriaxone trial group. The microbiological cure was not comparable in either groups (p=0.135).

Clinical Effectiveness of Azithromycin Versus Ciprofloxacin in the Treatment of Uncomplicated Enteric Fever in Children;

“…This comparative study between azithromycin and ciprofloxacin for uncomplicated enteric fever in children displayed high responsiveness of azithromycin with clinical efficacy more than 90%, resembling the results of many studies done previously. 8,18,19 Few studies reported the efficacy of azithromycin therapy in adults but not significant enough in children, contrary to our results where majority responded well to azithromycin. 20,21 The optimal dosing regimen of azithromycin for the treatment of enteric fever is yet to be determined.…”

“…6 Several trials have demonstrated azithromycin efficacy better with reduction of relapse, duration of hospital stay, clinical failure rate and well tolerated than many other competitive drugs. [7][8][9] In our region, though azithromycin and ciprofloxacin are amongst most commonly prescribed oral antibiotics in uncomplicated enteric fever as an empirical therapy but concerns persist regarding variations in response to treatment which is evident from a huge study carried out in Bangladesh. 10 Recently, many cases have been reported in Pakistan regarding extensively drug resistant strains of Salmonella typhi, responsible for a large typhoid outbreak.…”