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OBJECTIVES: To compare the defervescence period of azithromycin versus ceftriaxone in children with enteric fever.
METHODS: This open-label, randomized-controlled trial was conducted at Pediatrics Department, Federal Government Polyclinic Hospital, Islamabad, Pakistan from June 30, 2015 to December 30, 2015. Sample Size calculated was 99 by using WHO Sample Size Calculator. Patients of either gender, aging 2-12 years, diagnosed as enteric fever were eligible for study. One hundred eligible patients selected through non-probability consecutive sampling technique were recruited in the study, after seeking an informed consent from the parents. These patients were randomized through lottery method in two groups of equal size (n=50 each). Group A, received oral azithromycin suspension/capsule (10mg/kg/day; maximum dose, 500mg/day) administered once daily for 7 days, while Group B received intravenous (I/V) ceftriaxone (75mg/kg/day; maximum dose, 2.5 g/day) administered twice daily for 10 days. The clinical response to the therapy of both drugs was calculated in terms of number of days taken for defervescence. Data was analyzed in SPSS version 22.0.
RESULTS: Out of 100 patients, 64 (64%) were males and 36 (36%) were females and mean age of patients was 7.08±3.013 years. Patients on azithromycin had the mean time of defervescence 4.08±0.922 days and patients on ceftriaxone, the mean time of defervescence was 4.06±1.038 (p=0.919).
CONCLUSION: There is no significant difference between oral azithromycin and intravenous ceftriaxone in term of defervescence period for the treatment of enteric fever in children. azithromycin could be a suitable alternative owing to its convenient dosing and monitored on outpatient basis.
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2. Qaiser S, Irfan S, Khan E, Ahsan T, Zafar A. In vitro susceptibility of Typhoidal Salmonellae against newer antimicrobial agents: a search for alternate treatment options. J Pak Med Assoc 2011;61(5):462-5.
3. Patel K, Goldman JL. Safety concerns surrounding quinolone use in children. J Clin Pharmacol 2016 Sep 1;56(9):1060-75. DOI: 10.1002/jcph.715.
4. Zmora N, Shrestha S, Neuberger A, Paran Y, Tamrakar R, Shrestha A, et al. Open label comparative trial of mono versus dual antibiotic therapy for typhoid fever in adults. PLoS Negl Trop Dis 2018;12(4):e0006380. DOI: 10.1371/journal.pntd.0006380.
5. Nagaraj P, Sivathanu S, Manickam K, Kumar S, Kumar S, Sampath S. To study the effectiveness of oral azithromycin as compared to parenteral ceftriaxone in the treatment of uncomplicated enteric fever. J Pediatr Infect Dis 2016;11:113–7.DOI: 10.1055/s-0036-1593889
6. Vishwanath, Rohit S. Azithromycin versus ceftriaxone--which is better in uncomplicated typhoid fever? A clinical trial in a tertiary care hospital. J Evol Med Dent Sci. 2019; 8(17):1394.
7. Khatun H, Islam SB, Naila NN, Islam SA, Nahar B, Alam NH, et al. Clinical profile, antibiotic susceptibility pattern of bacterial isolates and factors associated with complications in culture‐proven typhoid patients admitted to an urban hospital in Bangladesh. Trop Med Int Health 2018 Apr;23(4):359-66. DOI: 10.1111/tmi.130372018.
8. Veeraraghavan B, Pragasam AK, Bakthavatchalam YD, Ralph R. Typhoid fever: issues in laboratory detection, treatment options & concerns in management in developing countries. Future Sci OA 2018 Jun 26;4(6):FSO312. DOI: 10.4155/fsoa-2018-0003.
9. Aziz S, Malik L. Emergence of multi-resistant enteric infection in a paediatric unit of Karachi, Pakistan. J Pak Med Assoc 2018;68(12):1848-50.
10. Ayub U, Khattak AA, Saleem A, Javed F, Siddiqui N, Hussain N. Incidence of Typhoid Fever in Islamabad, Pakistan. Am-Euras J Toxicol Sci 2015;7(4):220-3.
11. Sushila D, Rooma M, Priyanka S, Archana S, Rakesh L, Kabra SK, et al. Current antibiotic use in the treatment of enteric fever in children. Indian J Med Res 2019 Feb; 149(2): 263–9. DOI: 10.4103/ijmr.IJMR_199_18.
12. Islam A, Butler T, Kabir I, Alam NH. Treatment of typhoid fever with ceftriaxone for 5 days or chloramphenicol for 14 days: a randomized clinical trial. Antimicrob Agents Chemother 1993;37(8):1572-5. DOI: 10.1128/aac.37.8.1572.
13. Dutta P, Rasaily R, Saha MR, Mitra U, Bhattacharya SK, Bhattacharya MK, et al. Ciprofloxacin for treatment of severe typhoid fever in children. Antimicrob Agents Chemother 1993;37(5):1197-9. DOI: 10.1128/aac.37.5.1197.
14. Aggarwal A, Ghosh A, Gomber S, Mitra M, Parikh AO. Efficacy and safety of azithromycin for uncomplicated typhoid fever: an open label non-comparative study. Indian Pediatr 2011; 48(7):553-6. DOI: 10.1007/s13312-011-0093-y.
15. Saha SK, Talkukder SY, Islam M, Saha S. A highly ceftriaxone resistant salmonella typhi in Bangladesh. Peadiatr Infect Dis J 1999; (18):387. DOI: 10.1097/00006454-199904000-00018.
16. Capoor MR, Nair D, Hasan AS, Aggarwal P, Gupta B. Typhoid fever: narrowing therapeutic options in India. Southeast Asian J Trop Med Public Health 2006;37(6):1170-74.
17. Capoor MR, Nair D, Deb M, Aggarwal P. Enteric fever perspective in India: emergence of high-level ciprofloxacin resistance and rising MIC to cephalosporins. J Med Microbiol 2007; 56:1131-32.
18. Chinh TN, Parry CM, Ha HD, Ly NT, Thong MX, Wain J, et al. A Randomized Controlled Comparison of Azithromycin and Ofloxacin for Treatment of Multidrug-Resistant or Nalidixic Acid-Resistant Enteric Fever. Antimicrob Agents Chemother 2000; 44:1855-59. DOI: 10.1128/aac.44.7.1855-1859.2000.
19. Rai S, Jain S, Prasad KN, Ghoshal U, Dhole TN. Rationale of azithromycin prescribing practices for enteric fever in India. Indian J Med Microbiol 2012;30(1):30-3. DOI: 10.4103/0255-0857.93017.
20. Capoor MR, Rawat D, Nair D, Hasan AS, Deb M, Aggarwal P, et al. In vitro activity of Azithromycin, newer quinolones and cephalosporins in ciprofloxacin-resistant Salmonella causing enteric fever. J Med Microbiol 2007;56(11):1490-94. DOI: 10.1099/jmm.0.47353-0.
21. Gordillo ME, Singh KV, Murray BE. In vitro activity of azithromycin against bacterial enteric pathogens. Antimicrob Agents Chemother 1993;37(5):1203-05. DOI: 10.1128/aac.37.5.1203.
22. Chandey M, Multani AS. A comparative study of efficacy and safety of Azithromycin and Ofloxacin in uncomplicated typhoid fever. J Clin Diagn Res 2012;6(10):1736–39. DOI: 10.7860/JCDR/2012/4702.2631.
23. Jeeyani HN, Prajapati BS, Bloch A. Enteric fever in children - clinical profile, sensitivity patterns and response to antimicrobials. GCSMC J Med Sci 2015;4(1):40-3.
24. Upadhyay R, Nadka MY, Muruganathan A, Tiwaskar M, Amarapurkar D, Banka NH, et al. API recommendations for the management of typhoid fever. J Assoc Physicians India 2015;63(11):77-96.
25. Mushtaq S, Bhat AA, Rather GN, Akhter R, Bhat I, Wani T. Clinical profile of enteric fever in tertiary care hospital of Kashmir. Int J Contemp Pediatr 2017;4(5): 1754-7. DOI: 10.18203/2349-3291.ijcp20173779