Pefloxacin versus chloramphenicol in the therapy of typhoid fever

Cristiano, P; Iovene, Maria Rosaria; Imperatore, C.; Imparato, L; Maio, Patrizia; Carpinelli, C.; Corrado, M. F.; Lauria, Francesco

doi:10.1007/bf01833875

Cited by 11 publications

(7 citation statements)

References 13 publications

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“…We excluded trials using norfloxacin60 61 62 since this is not recommended for treating enteric fever because of its low oral bioavailability 10. We included 20 trials in the present analysis—fluoroquinolones were compared with chloramphenicol (10 trials),63 64 65 66 67 68 69 70 71 72 ceftriaxone (three trials),73 74 75 cefixime (three trials),39 76 77 and azithromycin (four trials) 4078 79 80…”

Section: Resultsmentioning

confidence: 99%

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A comparison of fluoroquinolones versus other antibiotics for treating enteric fever: meta-analysis

Thaver

Zaidi

Critchley

et al. 2009

BMJ

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Objectives To review evidence supporting use of fluoroquinolones as first line agents over other antibiotics for treating typhoid and paratyphoid fever (enteric fever). Design Meta-analysis of randomised controlled trials. Data sources Cochrane Infectious Diseases Group specialised register, CENTRAL (issue 4, 2007), Medline , Embase , LILACS , selected conferences, reference lists, and ongoing trial register (November 2007). Review methods Trials comparing fluoroquinolones with chloramphenicol, cephalosporins, or azithromycin in culture-proven enteric fever were included. Two reviewers extracted data and assessed methodological quality. Odds ratios with 95% confidence intervals were estimated. Trials recruiting over 60% children were analysed separately from trials on adults. Primary outcomes studied were clinical failure, microbiological failure, and relapse. Results Twenty trials were included. Trials were small and often of limited methodological quality. Only 10 trials concealed allocation and only three were blinded. In trials on adults, fluoroquinolones were not significantly different from chloramphenicol for clinical failure (594 participants) or microbiological failure (n=378), but reduced clinical relapse (odds ratio 0.14 (95% confidence interval 0.04 to 0.50), n=467, 6 trials). Azithromycin and fluoroquinolones were comparable (n=152, 2 trials). Compared with ceftriaxone, fluoroquinolones reduced clinical failure (0.08 (0.01 to 0.45), n=120, 3 trials) but not microbiological failure or relapse. Compared with cefixime, fluoroquinolones reduced clinical failure (0.05 (0.01 to 0.24), n=238, 2 trials) and relapse (0.18 (0.03 to 0.91), n=218, 2 trials). In trials on children infected with nalidixic acid resistant strains, older fluoroquinolones (ofloxacin) produced more clinical failures than azithromycin (2.67 (1.16 to 6.11), n=125, 1 trial), but there were no differences with newer fluoroquinolones (gatifloxacin, n=285, 1 trial). Fluoroquinolones and cefixime were not significantly different (n=82, 1 trial). Conclusions In adults, fluoroquinolones may be better than chloramphenicol for preventing clinical relapse. Data were limited for other comparisons, particularly for children. INTRODUCTIONEnteric fever (typhoid or paratyphoid fever) caused by Salmonella serotype Typhi (S Typhi) or Salmonella serotype Paratyphi (S Paratyphi) remains endemic in many areas of the developing world, causing over 26 million infections and over 200 000 deaths annually.

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Section: Resultsmentioning

confidence: 99%

“…Duration of fluoroquinolone treatment ranged from three days72 to 15 days 6670 Twelve trials had adequate methods of randomisation,39 40 66 70 71 72 74 75 77 78 79 80 and 10 of these had adequate allocation concealment 3940 71 72 74 75 77 78 79 80 Three were “double blinded.”63 64 65 Final follow-up of confirmed cases was adequate in 13 40…”

Section: Resultsmentioning

confidence: 99%

A comparison of fluoroquinolones versus other antibiotics for treating enteric fever: meta-analysis

Thaver

Zaidi

Critchley

et al. 2009

BMJ

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“…The succinate ester prodrug is used for intravenous or intramuscular administration and gives lower serum levels than the oral form (436,437). Chloramphenicol has been shown to be clinically effective in a number of studies (341,(438)(439)(440)(441)(442)(443)(444)(445)(446)(447). Disadvantages of chloramphenicol are its four-times-daily administration and the need to give it for at least 2 weeks to reduce the 10 to 15% risk of relapse.…”

Section: Traditional First-line Antimicrobialsmentioning

confidence: 99%

“…The drugs were concentrated intracellularly at the site of infection (484,485) and were rapidly bactericidal in vitro (481,486). When given for duration of 7 to 14 days, fluoroquinolones were often 100% effective with very low levels of relapse (329,342,443,470,(487)(488)(489)(490)(491)(492)(493)(494)(495)(496)(497)(498)(499)(500)(501)(502)(503)(504)(505). The clinical response was rapid, with fever resolution within 3 to 5 days.…”

Section: Fluoroquinolonesmentioning

confidence: 99%

Epidemiology, Clinical Presentation, Laboratory Diagnosis, Antimicrobial Resistance, and Antimicrobial Management of Invasive Salmonella Infections

et al. 2015

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SUMMARY Salmonella enterica infections are common causes of bloodstream infection in low-resource areas, where they may be difficult to distinguish from other febrile illnesses and may be associated with a high case fatality ratio. Microbiologic culture of blood or bone marrow remains the mainstay of laboratory diagnosis. Antimicrobial resistance has emerged in Salmonella enterica , initially to the traditional first-line drugs chloramphenicol, ampicillin, and trimethoprim-sulfamethoxazole. Decreased fluoroquinolone susceptibility and then fluoroquinolone resistance have developed in association with chromosomal mutations in the quinolone resistance-determining region of genes encoding DNA gyrase and topoisomerase IV and also by plasmid-mediated resistance mechanisms. Resistance to extended-spectrum cephalosporins has occurred more often in nontyphoidal than in typhoidal Salmonella strains. Azithromycin is effective for the management of uncomplicated typhoid fever and may serve as an alternative oral drug in areas where fluoroquinolone resistance is common. In 2013, CLSI lowered the ciprofloxacin susceptibility breakpoints to account for accumulating clinical, microbiologic, and pharmacokinetic-pharmacodynamic data suggesting that revision was needed for contemporary invasive Salmonella infections. Newly established CLSI guidelines for azithromycin and Salmonella enterica serovar Typhi were published in CLSI document M100 in 2015.

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“…Mild and transient epigastric pain were reported by Morelli et al (1992) and Cristiano et al (1995) in 6 and 5, respectively, of 30 patients suffering from typhoid fever that received an oral dose of 2 g chloramphenicol per person per day for a period of 15 days. Applying the same dose regimen, Carcelen et al (1989) reported moderate sideroblastic anaemia in one and moderate neutropenia in another one of 33 patients after seven days of treatment.…”

Section: Clinical Trialsmentioning

confidence: 99%

Scientific Opinion on Chloramphenicol in food and feed

2014

EFS2

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Chloramphenicol is an antibiotic not authorised for use in food-producing animals in the European Union (EU). However, being produced by soil bacteria, it may occur in plants. The European Commission asked EFSA for a scientific opinion on the risks to human and animal health related to the presence of chloramphenicol in food and feed and whether a reference point for action (RPA) of 0.3 µg/kg is adequate to protect public and animal health. Data on occurrence of chloramphenicol in food extracted from the national residue monitoring plan results and from the Rapid Alert System for Food and Feed (RASFF) were too limited to carry out a reliable human dietary exposure assessment. Instead, human dietary exposure was calculated for a scenario in which chloramphenicol is present at 0.3 µg/kg in all foods of animal origin, foods containing enzyme preparations and foods which may be contaminated naturally. The mean chronic dietary exposure for this worst-case scenario would range from 11 to 17 and 2.2 to 4.0 ng/kg b.w. per day for toddlers and adults, respectively. The potential dietary exposure of livestock to chloramphenicol was estimated to be below 1 µg/kg b.w. per day. Chloramphenicol is implicated in the generation of aplastic anaemia in humans and causes reproductive/hepatotoxic effects in animals. Margins of exposure for these effects were calculated at 2.4 × 10 5 or greater and the CONTAM Panel concluded that it is unlikely that exposure to food contaminated with chloramphenicol at or below 0.3 µg/kg is a health concern for aplastic anaemia or reproductive/hepatotoxic effects. Chloramphenicol exhibits genotoxicity but, owing to the lack of data, the risk of carcinogenicity cannot be assessed. The SUMMARYChloramphenicol is a broad-spectrum antibiotic effective against Gram-positive and Gram-negative bacteria and, in the past, has been widely used to treat infections in both humans and animals. Chloramphenicol is not authorised for use in food-producing animals in the European Union (EU) but may be used in human medicine and in treatments for non-food-producing animals. Apart from its potential occurrence as a residue in food from illicit treatment of food-producing animals, chloramphenicol has also been used in feed and food enzyme products and may occur naturally in plants from its production by the soil bacterium Streptomyces venezuelae.The EFSA Scientific Opinion entitled "Guidance on methodological principles and scientific methods to be taken into account when establishing Reference Points for Action (RPAs) for non-allowed pharmacologically active substances present in food of animal origin" identified an approach for establishing RPAs for various categories of non-allowed pharmacologically active substances. However, the opinion also identified certain categories of non-allowed pharmacologically active substances that are considered to be outside the scope of the procedure, including substances causing blood dyscrasias (aplastic anaemia) such as chloramphenicol. As chloramphenicol is excluded fro...

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Pefloxacin versus chloramphenicol in the therapy of typhoid fever

Cited by 11 publications

References 13 publications

A comparison of fluoroquinolones versus other antibiotics for treating enteric fever: meta-analysis

A comparison of fluoroquinolones versus other antibiotics for treating enteric fever: meta-analysis

Epidemiology, Clinical Presentation, Laboratory Diagnosis, Antimicrobial Resistance, and Antimicrobial Management of Invasive Salmonella Infections

Scientific Opinion on Chloramphenicol in food and feed

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