Randomized Treatment of Patients with Typhoid Fever by Using Ceftriaxone or Chloramphenicol

Enteric Fever Due To Multi-Resistant Salmonella Typhi

“…The patients became afebrile within four days of therapy. Similar results were reported in a randomized study comparing ceftriaxone to chloramphenicol in the management of typhoid fever [21]. However, the fourth patient, who failed to respond to ceftriaxone and remained febrile for up to 12 days, was later successfully treated with ciprofloxacin orally.…”

Treatment of typhoid fever with ceftriaxone for 5 days or chloramphenicol for 14 days: a randomized clinical trial

“…No other side effects in patients of either treatment group were noted, except that one patient in the Patients treated with ceftriaxone, on the other hand, were more likely to remain febrile for a week or more after the start of treatment than patients treated with chloramphenicol. The proportion of patients having prolonged fever (lasting .10 days) was 32% for patients treated with ceftriaxone, compared with 23% reported by Islam et al (8) for patients with typhoid fever who were treated with ceftriaxone for 7 days. The reasons for prolonged fever in some cases were superinfections leading to pneumonia or urinary tract infection.…”

“…However, newer antibiotics with good in vivo activity against Salmonella typhi are needed because of the alarming spread of R-factor-mediated chloramphenicol-resistant S. typhi throughout the world (3,4,11,23). Recently, ceftriaxone has emerged as a satisfactory alternative to chloramphenicol (1,2,5,8,10,12,13,21,22).Ceftriaxone has good broad-spectrum activity against gram-positive and gram-negative bacteria, including S. typhi (15). It has a long half-life in serum (ranging from 6.0 to 8.6 h), making it suitable for a once-daily dose regimen (16,20).…”

“…It has a long half-life in serum (ranging from 6.0 to 8.6 h), making it suitable for a once-daily dose regimen (16,20). Randomized trials comparing chloramphenicol to ceftriaxone given once daily for 7 days for typhoid fever in Bangladesh (8) showed an efficacy of ceftriaxone comparable to that of chloramphenicol. The need for less expensive, shorter regimens prompted us to evaluate further the efficacy of ceftriaxone for treating typhoid fever in both children and adults; use of ceftriaxone would reduce the duration of therapy to 5 4 2 included one patient who had a relapse after discharge, two who developed pneumonia in the hospital, one who developed a urinary tract infection, and two who remained febrile for more than 14 days after the start of treatment without an apparent cause for the fever and were given chloramphenicol.…”

Failure of Short-Course Ceftriaxone Chemotherapy for Multidrug-Resistant Typhoid Fever in Children: a Randomized Controlled Trial in Pakistan

“…In contrast, a 95% cure rate was seen among children with MDR typhoid in Egypt who were randomly selected to receive a 5-day course of CRO (11). In the latter study, Girgis et al (11) also observed that the time-to-defervescence with CRO was only 3.9 days, which was considerably shorter than the observed pattern of defervescence for MDR typhoid in other parts of Asia (1,7,14,15). It is thus possible that these differences in response to therapy may represent differences in the virulence and antibiotic responsiveness of different strains of S. typhi.…”