Combination therapy with ofloxacin and chloramphenicol against typhoid fever

Recently we experienced two male typhoid patients who required additional treatment with CP sodium succinate (CP succinate) to OFLX therapy. Although both of the cases were administered 900 mg/day of OFLX orally for three and four days, respectively, the clinical efficacies were not sufficient. We added 2.0 g/day of CP succinate intravenously for six days, although a lasting high fever returned to normal level in a few days. The administration of OFLX was continued up to 14 days. The daily doses of OFLX during the co-medication with CP succinate were 600 mg in one case and 900 mg in the other case. In both cases no recurrence was observed clinically and bacteriologically for six months after their discharge. No adverse reaction was observed throughout the therapy.     

Successful aztreonam treatment of acute typhoid fever after chloramphenicol failure

Aztreonam treatment was successful in 4 cases of typhoid fever. The patients were seriously ill with growth of Salmonella typhi in blood cultures despite treatment with chloramphenicol. Aztreonam appears to be a useful alternative to standard therapy of typhoid fever.     

Randomized treatment of patients with typhoid fever by using ceftriaxone or chloramphenicol

Sixty-three patients with Salmonella typhi infections were randomly assigned to receive either ceftriaxone iv in single daily doses of 75 mg/kg for children and 3-4 g for adults for seven days or to receive 60 mg of chloramphenicol/kg a day orally or iv in four divided doses until defervescence and then 40 mg/kg a day to complete 14 d. In the ceftriaxone group, one death occurred, and two of seven patients still febrile 11 d after starting treatment were given chloramphenicol. In the chloramphenicol group, one death and one gastrointestinal perforation occurred. The probability of remaining febrile was similar for both groups during the first seven days but was significantly greater for patients receiving ceftriaxone during the 14-d period. Patients in the chloramphenicol group were more likely to be bacteremic on day 3. These results suggest that a seven-day course of once-daily ceftriaxone shows promise as an alternative to 14 d of chloramphenicol for treating typhoid fever.     

Clinical experience with pefloxacin in the therapy of typhoid fever

Summary Thirty hospitalized patients (22 men and eight women), aged between 15 and 41 years (mean = 25.4 years), with severe proven typhoid sepsis were treated with pefloxacin at daily dose of 1200 mg, divided in three doses, intravenously for the first five days and orally for the following ten days of treatment. All patients completely recovered from infection and pathogens were eradicated after 30 days of follow-up. In none of the patients was a relapse registered during the follow-up or enteric carrier state after disease. Pefloxacin therapy was well tolerated by all patients: in five patients a mild and transient epigastric pain and in one patient a mild and transient nausea were registered. Pefloxacin is a safe and effective agent for therapy of typhoid fever.

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Klinische Erfahrung mit Pefloxacin in der Behandlung des Typhus

Zusammenfassung 30 stationäre Patienten mit gesichertem, septisch verlaufendem Typhus (22 Männer, acht Frauen; Alter 15 bis 41 Jahre, im Mittel 25,4 Jahre) erhielten fünf Tage lang Pefloxacin intravenös in einer Gesamttagesdosis von 1200 mg, aufgeteilt in drei Einzeldosen. Die Therapie wurde für weitere zehn Tage oral fortgesetzt. Alle Patienten haben sich von der Infektion vollständig erholt, nach einer Beobachtungszeit von 30 Tagen waren in allen Fällen die Erreger eliminiert. Während der Nachbeobachtungszeit war bei keinem der Patienten ein Rezidiv aufgetreten oder Erregerausscheidung im Stuhl festzustellen. Die Therapie war in fünf Fällen mit leichten, vorübergehenden epigastrischen Schmerzen und in einem Fall mit leichter, passagerer Übelkeit assoziiert. Pefloxacin ist ein sicheres und wirksames Medikament für die Behandlung des Typhus.

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These results were presented at the 6th Mediterranean Congress of Chemotherapy, Taormina, Giardini Naxos, Italy, 22–27 May 1988.     

Fever of unknown origin: subacute thyroiditis versus typhoid fever

Fever of unknown origin (FUO) is not infrequently a diagnostic dilemma for clinicians. Common infectious causes include endocarditis and abscesses in adults, and noninfectious causes include neoplasms and certain collagen vascular diseases, for example, polymyalgia rheumatica, various vasculitides, and juvenile rheumatoid arthritis (adult Still's disease). Subacute thyroiditis is a rare cause of FUO. Among the infectious causes of FUO, typhoid fever is relatively uncommon. We present a case of FUO in a traveler returning from India whose initial complaints were that of left-sided neck pain and angle of the jaw pain, which initially suggested the diagnosis of subacute thyroiditis. After an extensive FUO workup, when typhoid fever is a likely diagnostic possibility, an empiric trial of anti- Salmonella therapy has diagnostic and therapeutic significance. The presence of relative bradycardia, and response to quinolone therapy, was the basis of the clinical diagnosis of typhoid fever as the explanation for this patients FUO. This case illustrates the diagnostic difficulties in assessing patients with FUO with few diagnostic findings.     

Azithromycin versus ceftriaxone for the treatment of uncomplicated typhoid fever in children.

A total of 108 children aged 4-17 years were randomized to receive 7 days of azithromycin (10 mg/kg/day; maximum, 500 mg/day) or ceftriaxone (75 mg/kg/day; maximum, 2.5 g/day), to assess the efficacy of the agents for the treatment of uncomplicated typhoid fever. Salmonella typhi was isolated from the initial cultures of blood samples from 64 patients. A total of 31 (91%) of the 34 patients treated with azithromycin and 29 (97%) of the 30 patients treated with ceftriaxone were cured (P>.05). All 64 isolates were susceptible to azithromycin and ceftriaxone. Of the patients treated with ceftriaxone, 4 subsequently had relapse of their infection. No serious side effects occurred in any study subject. Oral azithromycin administered once daily appears to be effective for the treatment of uncomplicated typhoid fever in children. If these results are confirmed, the agent could be a convenient alternative for the treatment of typhoid fever, especially in individuals in developing countries where medical resources are scarce.     

Multidrug-resistant typhoid fever

One hundred children (consecutive) with positive blood culture for Salmonella typhi were studied for clinical profile and complications.The common clinical features were fever (100%), vomiting (58%), abdominal pain (48%), cough (22%) and loose stools (14%) and the Widal test was positive in 75% patients. Eighty per cent of the salmonella isolates were resistant to amoxycillin, chloramphenicol and co-trimoxazole drugs, but all were sensitive to ciprofloxacin and ceftriaxone. Forty patients developed complications: encephalopathy (18), melaena (12), haematemesis (10), epistaxis (4), hepatitis (4), acalculous cholecystitis (4), bowel perforation (3) and nephritis (2). Complications were more frequent in children with multidrug-resistant typhoid.The final antibiotic required to render the children afebrile included ciprofloxacin (80), ceftriaxone, amoxycillin (4), chloramphenicol (4), amoxycillin and gentamicin (4), amoxycillin with chloramphenicol (2), and furazolidone (2).The defervesence time was least with ceftriaxone and greatest with amoxycillin. All the affected children made a complete recovery.