BACKGROUND: Despite concerns about safety in children, fluoroquinolone antibiotics have become the treatment of choice in patients with multidrug-resistant typhoid fever in Vietnam. However, quinolone-resistant strains of Salmonella typhi have recently been reported from Vietnam; and if quinolone resistance becomes established, alternative oral treatment options will be needed. OBJECTIVE:Cefixime, an orally administered third generation cephalosporin, was compared with ofloxacin for the treatment of uncomplicated typhoid fever in children. METHODS: In an open trial children with suspected typhoid fever were randomized to receive either ofloxacin (10 mg/kg/day in two divided doses) for 5 days or cefixime (20 mg/kg/day in two divided doses) for 7 days. RESULTS: S. typhi was isolated from 82 patients (44 in the cefixime group, 38 in theofloxacin group) and 70 (85%) of the isolates were multidrug-resistant. Median (95% confidence interval, range) fever clearance times were 4.4 (4 to 5.2, 0.2 to 9.9) days for ofloxacin recipients and 8.5 (4.2 to 9, 1.8 to 15.2) days for cefixime-treated patients (P < 0.0001). There were 11 treatment failures (10 acute and one relapse) in the cefixime group and 1 acute treatment failure in the ofloxacin group (mean difference, 22%; 95% confidence interval, 9 to 36%). CONCLUSION: Short course treatment with cefixime may provide a useful alternative treatment in cases of uncomplicated typhoid fever in children, but it is less effective than short course treatment with ofloxacin.
RCT Entities:
BACKGROUND: Despite concerns about safety in children, fluoroquinolone antibiotics have become the treatment of choice in patients with multidrug-resistant typhoid fever in Vietnam. However, quinolone-resistant strains of Salmonella typhi have recently been reported from Vietnam; and if quinolone resistance becomes established, alternative oral treatment options will be needed. OBJECTIVE:Cefixime, an orally administered third generation cephalosporin, was compared with ofloxacin for the treatment of uncomplicated typhoid fever in children. METHODS: In an open trial children with suspected typhoid fever were randomized to receive either ofloxacin (10 mg/kg/day in two divided doses) for 5 days or cefixime (20 mg/kg/day in two divided doses) for 7 days. RESULTS:S. typhi was isolated from 82 patients (44 in the cefixime group, 38 in the ofloxacin group) and 70 (85%) of the isolates were multidrug-resistant. Median (95% confidence interval, range) fever clearance times were 4.4 (4 to 5.2, 0.2 to 9.9) days for ofloxacin recipients and 8.5 (4.2 to 9, 1.8 to 15.2) days for cefixime-treated patients (P < 0.0001). There were 11 treatment failures (10 acute and one relapse) in the cefixime group and 1 acute treatment failure in the ofloxacin group (mean difference, 22%; 95% confidence interval, 9 to 36%). CONCLUSION: Short course treatment with cefixime may provide a useful alternative treatment in cases of uncomplicated typhoid fever in children, but it is less effective than short course treatment with ofloxacin.
Authors: Christopher M Parry; Vo Anh Ho; Le Thi Phuong; Phan Van Be Bay; Mai Ngoc Lanh; Le Thanh Tung; Nguyen Thi Hong Tham; John Wain; Tran Tinh Hien; Jeremy J Farrar Journal: Antimicrob Agents Chemother Date: 2006-12-04 Impact factor: 5.191
Authors: Christopher M Parry; Chau Tran Thuy; Sabina Dongol; Abhilasha Karkey; Ha Vinh; Nguyen Tran Chinh; Pham Thanh Duy; Tran Vu Thieu Nga; James I Campbell; Nguyen Van Minh Hoang; Amit Arjyal; Zulfiqar A Bhutta; Sujit K Bhattacharya; Magdarina D Agtini; Baiqing Dong; Do Gia Canh; Aliya Naheed; John Wain; Tran Tinh Hien; Buddha Basnyat; Leon Ochiai; John Clemens; Jeremy J Farrar; Christiane Dolecek; Stephen Baker Journal: Antimicrob Agents Chemother Date: 2010-09-13 Impact factor: 5.191
Authors: Sarah J Dunstan; Nguyen Thi Hue; Buhm Han; Zheng Li; Trinh Thi Bich Tram; Kar Seng Sim; Christopher M Parry; Nguyen Tran Chinh; Ha Vinh; Nguyen Phu Huong Lan; Nga Tran Vu Thieu; Phat Voong Vinh; Samir Koirala; Sabina Dongol; Amit Arjyal; Abhilasha Karkey; Olita Shilpakar; Christiane Dolecek; Jia Nee Foo; Le Thi Phuong; Mai Ngoc Lanh; Tan Do; Tin Aung; Do Nu Hon; Yik Ying Teo; Martin L Hibberd; Katherine L Anders; Yukinori Okada; Soumya Raychaudhuri; Cameron P Simmons; Stephen Baker; Paul I W de Bakker; Buddha Basnyat; Tran Tinh Hien; Jeremy J Farrar; Chiea Chuen Khor Journal: Nat Genet Date: 2014-11-10 Impact factor: 38.330