Two or three days of ofloxacin treatment for uncomplicated multidrug-resistant typhoid fever in children

Abstract

An open randomized comparison of 2 days (Ofx2) versus 3 days (Ofx3) of oral ofloxacin treatment (15 mg/kg/ day) was conducted with Vietnamese children between 1 and 15 years of age with suspected typhoid fever. Of 108 children enrolled, 100 were blood culture positive for Salmonella typhi, and 86% of the isolates were multidrug resistant. There were no significant adverse effects. The therapeutic responses were similar in both groups, with mean (؎ standard deviation) fever clearances of 107 ؎ 60 h in the Ofx3 group and 100 ؎ 64 h in the Ofx2 group (P > 0.2). There were six ''clinical'' failures in the Ofx2 group and two clinical failures in the Ofx3 group (P > 0.2), in which fever and symptoms persisted for more than 1 week after the start of treatment, but only one of these was culture positive (Ofx3). There was one suspected relapse, and one carrier was identified. Short courses of ofloxacin are simple, inexpensive, safe, and effective for the treatment of uncomplicated multidrug-resistant typhoid fever.

Antibacterial activity of cefixime against Salmonella typhi and applicability of Etest

“…[1][2][3][4] Approximately one-fourth of the strains (18/73) we used in this study were found to be resistant to chloramphenicol and cotrimoxazole. Above all, 12 strains were also resistant to amoxicillin by producing common TEM-1 type -lactamase.…”

“…However, cephalosporins had been considered ineffective for the treatment of infectious diseases caused by bacteria growing in mammalian cells because of their low penetrability into such cells Recent clinical studies have shown the excellent efficacy of thirdgeneration cephalosporins 2,5-7 as well as new quinolones 4,[9][10][11][12] for typhoid fever, which can be considered a systemic infection rather than a local intestinal infection such as shigellosis. New quinolones should not be administered to pediatric patients for reasons of possible adverse drug reactions.…”

“…Frequencies of these strains, called MDR (multidrug-resistant), are reported to be 78% (1990) in India, 1 75% (1995) in Egypt, 2 77% (1995) in Pakistan, 3 and 86% (1995) in Vietnam. 4 Reflecting this changing trend in antibiotic susceptibility of S. typhi, various new agents such as new quinolones and third-generation cephalosporins having strong in vitro activity have been tried clinically for the treatment of MDR S. typhi. The effectiveness of oral cefixime in the treatment of typhoid fever has also been reported clinically.…”

Short antibiotic treatment courses or how short is short?

“…Clinical failures were: six in the 2-day ofloxacin regimen and two cases in the 3-day ofloxacin regimen (P > 0.2). There was an additional one case of relapse and one failed case [5].…”

Current trends in typhoid fever

“…This regimen not only has a high cure rate (> 97%) but also has a very low relapse and carrier rate (< 1%) [61•]. Although a 7-to 10-day course is recommended, shorter courses (2-3 days) are often successful, assuming the isolate is sensitive to quinolones [62][63][64]. Other quinolones, including norfloxacin, ofloxacin, and levofloxacin can also be used [61•,62,64,65].…”