Efficacy of Azithromycin versus Ceftriaxone for the treatment of uncomplicated typhoid fever in children

Abstract

Introduction: Typhoid fever is a global major public health problem. Its incidence is high inchildren from both low & high socio economic groups. Antimicrobial therapy is important in itsmanagement. MDR case has begun to appear around 1990. Ciprofloxacin resistance was firstreported in Bangladesh in 2000.6 Ceftriaxone is still highly effective, but costly and requiresparental administration and cumbersome to children. So an effective, safe and alternative drugin the treatment of typhoid fever is always a demand. Azithromycin is a potential drug intreatment of typhoid fever because of its high intracellular penetration and long half-life (72hours). Aims & Objectives- To determine the efficacy of Azithromycin versus Ceftriaxone in thetreatment of uncomplicated typhoid fever. Methodology- This RCT was conducted in theDepartment of Paediatrics of Shaheed Mansur Ali Medical College & Hospital, Dhaka; over aperiod of 6 (six) months. A total of 35 cases (Azithromycin) & 35 controls (Ceftriaxone) wereincluded in this study. Results- Most respondents in both groups were ≤ 5 years’ age. Mean agewas 5.53±3.41years for cases and 5.53±2.55 years for controls (p-0.146). In both groups M:Fratio was 1:1. Mean weight was 17.30±6.13 kg for cases and 17.17± 6.55kg for control (p0.798). Most respondents were from middle socio-economic classes (p-0.083). Clinicalpresentation was similar in both groups. A quarter of participants in each group (25.7% &22.9%) gave history of receiving antibiotic before admission. ‘Widal test’ was negative in 2.9%of cases and 5.7% of Control (p-0.328). S. typhi. was present in blood culture in majority casesexcept, 14.3% in Azithromycin and 8.6% in Ceftriaxone group yelled ‘no growth’ (p-0.241).Repeat blood culture on day10, showed no growth in all the 54 culture positive cases. Childrenof Azithromycin group was afebrile within 6 days of starting treatment, mean 4.88± 0.40 daysand in Ceftriaxone group most (97.1%) required ≥7 days, mean 7.14±0.42 days (p-0.001). Asdefervescence was achieved before the completion of treatment, both the groups weredischarged in due time, i.e. Azithromycin group after 7 days and Ceftriaxone group after 10days. Conclusion- Treatment of uncomplicated typhoid fever with Azithromycin is relatively easier; takes shorter time to achieve defervescence and the duration of treatment is also shorter in comparison to Ceftriaxone.