cefotaxime and Typhoid-Fever

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.. Cefixime, an orally administered third generation cephalosporin, was compared with ofloxacin for the treatment of uncomplicated typhoid fever in children.. 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.. 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%).. 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.

Topics: Adolescent; Anti-Infective Agents; Cefixime; Cefotaxime; Cephalosporins; Child; Child, Preschool; Drug Resistance, Multiple; Female; Humans; Male; Ofloxacin; Typhoid Fever

We compared cefixime with chloramphenicol in a randomized trial for treatment of children with culture positive typhoid fever. Twenty children were given cefixime 10 mg/kg/day orally and twenty received chloramphenicol 50 mg/kg/day orally. On entry in the study, the clinical characteristics of the two groups were comparable. Duration of therapy was 14 days. Clinical cure was observed in 18 (90%) patients treated with cefixime and 9 (45%) treated with chloramphenical. Out of the 11 patients who did not respond to chloramphenicol, 10 were switched over to cefixime and all of them were cured. Over all 28 cases out of 30 (93.3%) P = 0.0049 were cured by cefixime.

Topics: Anti-Bacterial Agents; Cefixime; Cefotaxime; Cephalosporins; Child; Child, Preschool; Chloramphenicol; Female; Humans; Infant; Male; Treatment Outcome; Typhoid Fever

We compared cefixime with chloramphenicol in a trial for treatment of children with culture positive typhoid fever. Twenty children were given cefixime 10 mg/kg/day orally for 14 days and twenty received chloramphenicol 50 mg/kg/day orally for 14 days. On entry the clinical characteristics of the two groups were comparable. Clinical cure was observed in 18 (90%) patients treated with cefixime and 9 (45%) treated with chloramphenicol. Of 11 patients who did not respond to chloramphenicol, 10 were switched over to cefixime and all were cured. Overall 28 out of 30 cases (93.3%) were cured by cefixime.

Topics: Anti-Bacterial Agents; Cefixime; Cefotaxime; Cephalosporins; Child; Child, Preschool; Chloramphenicol; Female; Humans; Male; Remission Induction; Safety; Time Factors; Typhoid Fever

Enteric fever is a serious public health problem in Pakistan, where multidrug-resistant salmonellosis causes enteric fever with increased morbidity and mortality. Costly parenteral therapy and lack of an established safety profile for the use of quinolones in children necessitate evaluation of an oral treatment option. This study is meant to assess the efficacy, safety, and cost effectiveness of an oral third-generation cephalosporin (cefixime) in the treatment of multidrug-resistant enteric fever.. Between November 1993 and October 1994, 85 patients, 15 years of age or less, with culture-proven enteric fever were randomly assigned to two groups. Group A (n = 41) received cefixime at a dosage of 10 mg/kg to 12 mg/kg per day in two divided doses. Group B (n = 44) received chloramphenicol at a dosage of 100 mg/kg daily in four divided doses. Both groups were treated for 2 weeks.. In group A, 95% (39/41) of the patients receiving cefixime responded favorably, whereas in group B, 30% (14/45) responded to chloramphenicol. The 31 patients not cured in group B were then successfully treated with cefixime. Overall, cefixime was well tolerated. Subsequent antibiogram data showed an overall multidrug-resistance rate of 78% (66/85).. Cefixime is a safe, effective, and cheaper oral option for the treatment of multidrug-resistant enteric fever. Further studies are needed, however, to validate this observation.

Topics: Administration, Oral; Anti-Bacterial Agents; Cefixime; Cefotaxime; Cephalosporins; Child; Child, Preschool; Chloramphenicol; Cost-Benefit Analysis; Drug Resistance, Multiple; Female; Humans; Male; Prospective Studies; Salmonella typhi; Treatment Outcome; Typhoid Fever

We evaluated the clinical profile, outcome and serial plasma interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-alpha) concentrations in 38 consecutive children (aged 6 months-14 years) admitted with culture-proven multidrug-resistant typhoid. All children received therapy for 14 days with either i.v. ceftriaxone or oral cefixime, with comparable outcome. Concentrations of IL-6 and TNF-alpha were significantly elevated in over 50% of the cases and correlated with clinical severity of illness as quantitated by the typhoid morbidity score. Sequential measurements revealed a significant decrease in IL-6 and TNF-alpha concentrations within 7 days of initiation of therapy (P<0.05). While no clear relationship was seen with time-to-defervescence, the failure rate was significantly higher in children with baseline serum IL-6 values >400 pg/ml (P<0.05). Our data suggest that plasma cytokine activity is frequently elevated in children with typhoidal salmonellosis, and IL-6 concentrations show a correlation with clinical severity and recovery from the illness.

Topics: Adolescent; Cefixime; Cefotaxime; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Cohort Studies; Drug Resistance, Multiple; Enzyme-Linked Immunosorbent Assay; Female; Humans; Infant; Interleukin-6; Male; Morbidity; Salmonella typhi; Severity of Illness Index; Treatment Outcome; Tumor Necrosis Factor-alpha; Typhoid Fever

An increase in the incidence of Salmonella typhi strains resistant to chloramphenicol, ampicillin and trimethoprim-sulfamethoxazole causing enteric fever in Egyptian children stimulated the evaluation of alternative drugs. Children with positive blood cultures were treated with cefixime, ceftriaxone or aztreonam, and the efficacy, safety and cost of these regimens were evaluated and compared. Cefixime (7.5 mg/kg) was given orally twice daily to 50 children for 14 days, ceftriaxone (50 to 70 mg/kg) was given im once daily for 5 days to 43 children and aztreonam (50 to 70 mg/kg) was given im every 8 hours for 7 days to 31 children. Children in the 3 groups were comparable with regard to age, sex, duration and severity of illness before admission. All children were cured. A significant difference (P < 0.05) in duration of treatment before becoming afebrile seemed to favor ceftriaxone (3.9 days) over aztreonam (5.5 days) and cefixime (5.3 days). During the 4-week follow-up period relapses occurred in 3 (6%) children in the cefixime group, in 2 (5%) in the ceftriaxone group and in 2 (6%) in the aztreonam group. Safety and efficacy were comparable for all 3 drugs. Ceftriaxone was most cost-effective on an inpatient basis, because of a more rapid clinical cure, and cefixime was the most cost-effective on an outpatient basis, because of drug cost.

Topics: Adolescent; Anti-Bacterial Agents; Aztreonam; Bacteremia; Cefixime; Cefotaxime; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Cost-Benefit Analysis; Drug Resistance, Multiple; Egypt; Female; Humans; Male; Monobactams; Salmonella typhi; Treatment Outcome; Typhoid Fever

We randomly allocated 80 children with suspected multidrug-resistant tyhpoid fever to therapy with either cefixime or ceftriaxone. Of these, an alternative diagnosis was subsequently made in 10 children and another 10 were excluded because cultures were negative. In 9 cases the typhoidal organisms isolated were susceptible to first-line drugs. In all, 50 children were randomly allocated to receive therapy with either intravenous ceftriaxone (65 mg/kg/day once daily, Group A, n = 25) or oral cefixime (10 mg/kg/day divided every 12 hours, Group B, n = 25) for 14 days. The two groups were comparable in their clinical characteristics, duration and severity of illness at the time of admission. The time to defervescence was comparable in both groups (8.3 +/- 3.7 vs. 8.0 +/- 4.1 days, P = not significant). An equal number (3 in each group) failed to respond and underwent a change in therapy. Three children in Group A and one in Group B relapsed. No adverse effects were seen in either group during the course of therapy. Our data suggest that oral cefixime can be used as effectively as parenterally administered ceftriaxone for management of typhoid fever in children.

Topics: Administration, Oral; Adolescent; Anti-Bacterial Agents; Cefixime; Cefotaxime; Ceftriaxone; Child, Preschool; Drug Resistance, Multiple; Female; Humans; Infant; Injections, Intravenous; Male; Salmonella typhi; Typhoid Fever

Topics: Amoxicillin; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Chloramphenicol; Chloramphenicol Resistance; Drug Resistance, Microbial; Female; Humans; In Vitro Techniques; Infant; Male; Recurrence; Salmonella typhi; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

In 45 patients in whom typhoid fever was confirmed by culture of a blood sample, cefotaxime (1 gm BID) was administered intravenously for four days; if defervescence did not occur by day 5, the dosage was increased to 2 gm BID until defervescence, when it was reduced to 1 gm BID until discharge. On average, defervescence occurred on day 7 (range, day 3 to day 14), requiring a total dose of 31 gm (range, 12 to 60 gm) of cefotaxime. Relapse, occurring in three patients, was treated with co-trimoxazole. The duration of cefotaxime therapy was longer than therapy with chloramphenicol but without the risk of bone marrow depression.

Topics: Adolescent; Adult; Aged; Cefotaxime; Clinical Trials as Topic; Female; Humans; Male; Middle Aged; Recurrence; Salmonella typhi; Time Factors; Typhoid Fever

Enteric fever is one of the most common infectious diseases in the economically developing world and this bacterial infection is the common most cause of fever in travelers to these endemic areas. Even after the availability and deployment of preventive measures like vaccination against Salmonella typhi (S. typhi) and sanitation practices; effective treatment is paramount to reduce the associated morbidity and mortality. Cephalosporins are antimicrobials belonging to the β-lactam class with established efficacy, pharmacokinetic, and safety profile by virtue of which, they belong to the group of antibiotics most commonly utilized in clinical practice. They have a broadspectrum of activity against various gram-positive and gram-negative bacteria. Like penicillin, they belong to the β-lactam class of drugs. Amid such a scenario of rising antimicrobial resistance, a broad-spectrum antibiotic like cefotaxime is a real bliss. Distinctive properties of cefotaxime like broad-spectrum of activity, bactericidal action, stability against the common resistance-causing mechanisms, and good safety profile make it a reliable choice in the therapy landscape of enteric fever. It delivers desired efficacy in such difficult-to-treat scenarios at a manageable tolerability profile. Cefotaxime and ceftriaxone have a comparable spectrum of antimicrobial activity, but both differ in terms of pharmacokinetics. Considering the published literature, cefotaxime seems to be a dependable option for the management of typhoid owing to its effectiveness against S. typhi bundled with an acceptable tolerability profile.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Cefotaxime; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Salmonella typhi; Typhoid Fever

To determine the occurrence of bacterial pathogens responsible for diarrhea and to engender information regarding the effectiveness of commonly used antibiotic against diarrhea.. This cross-sectional study was conducted between April and July 2014. Samples were collected from the Divisional Headquarter and Allied Hospital, Faisalabad, Pakistan. The differential and selective media were used to isolate bacterial pathogens, which were identified through cultural characteristics, microscopy, and biochemical tests. Disc diffusion assay was carried out using Muller Hinton agar medium, and minimum inhibitory concentration was determined using broth dilution method against isolated pathogens.. One hundred and forty-one (100%) samples were positive for some bacteria. Frequency of occurrence was Bacillus cereus (B. cereus) (66%), Escherichia coli (E.coli) (48.5%), Salmonella typhi (S. Typhi) (27.7%), Pseudomonas aeruginosa (P. aeruginosa) (8.5%), and Staphylococcus aureus (S. aureus) (4.3%). Single pathogen was detected in 20 (14.2%) samples whereas combinations were found in 121 (85.8%) samples. Bacillus cereus and E.coli were the most frequently detected pathogens followed by the S. Typhi, P. aeruginosa, and Staph. aureus. The percentage occurrence of isolated pathogens was 31% in B. cereus, 31% in E. coli, 18% in S. Typhi, 5% in P. aeruginosa, and 3% in Staph. aureus.. Pseudomonas aeruginosa showed resistance against Amoxicillin and Cefotaxime, whereas S. aureus was found resistant against Cefotaxime. Statistical analysis using one way Analysis of Variance revealed that Ofloxacin and Gentamicin had significant (p less than 0.05) differences against all isolates as compared with other antibiotics used in this study.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amoxicillin; Anti-Bacterial Agents; Bacillus cereus; Cefotaxime; Child; Child, Preschool; Cross-Sectional Studies; Diarrhea; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Gentamicins; Gram-Positive Bacterial Infections; Humans; Infant; Infant, Newborn; Male; Microbial Sensitivity Tests; Middle Aged; Ofloxacin; Pakistan; Pseudomonas aeruginosa; Pseudomonas Infections; Salmonella typhi; Staphylococcal Infections; Staphylococcus aureus; Typhoid Fever; Young Adult

Typhoid fever is a systemic intracellular infection caused by Salmonellaenterica serotype Typhi. The emergence and spread of nalidixic acid-resistant S. Typhi (NARST) is challenging for clinicians in many countries owing to the lack of suitable treatment options. The aim of this study was to identify in vitro synergistic combinations of antibiotics against S. Typhi. In vitro time-kill studies were performed on three clinical NARST isolates and one type strain of nalidixic acid-susceptible S. Typhi (NASST) ATCC 9992 with ciprofloxacin, cefotaxime and azithromycin in various combinations. The combination of ciprofloxacin (0.012-0.375 microg/mL) and cefotaxime (0.063-0.125 microg/mL) against all three NARST strains and the NASST strain was significantly more effective in vitro in reducing bacterial counts by >or=3log(10) colony-forming units at 24h and showed synergistic effects. Combination therapy with ciprofloxacin and cefotaxime might be the treatment of choice for patients with typhoid fever. The combination of a fluoroquinolone and a beta-lactam, which are directed against different targets, may improve efficacy compared with a fluoroquinolone alone and may reduce the chance of fluoroquinolone-resistant mutants emerging in patients with severe typhoid fever.

Topics: Anti-Infective Agents; Cefotaxime; Ciprofloxacin; Drug Resistance, Bacterial; Drug Synergism; Humans; Microbial Sensitivity Tests; Nalidixic Acid; Salmonella typhi; Typhoid Fever

Typhoid fever complicated by multiple organ involvement has been rarely mentioned in the literature. We reported two cases of typhoid fever with several unusual manifestations, including acute renal failure, acute hepatitis, acute pancreatitis, disseminated intravascular coagulation, and lower gastrointestinal bleeding. A renal biopsy in the first case showed no pathological change. Bone marrow biopsy showed focal necrosis of matrix, which might have been due to severe illness. A liver biopsy in the second case showed a predominantly histiocytic proliferation with occasional neutrophilic infiltration in the portal areas and hepatic sinusoids. Focal necrosis, bile duct injury, and multiple eosinophilic bodies were also noted. After appropriate antimicrobial therapy, both patients recovered without any sequelae. The potential of multiple organ involvement is highlighted in typhoid fever, which, on rare occasions, may occur simultaneously in the same patient.

Topics: Acute Disease; Acute Kidney Injury; Adult; Cefotaxime; Disseminated Intravascular Coagulation; Gastrointestinal Hemorrhage; Hepatitis; Humans; Male; Pancreatitis; Salmonella typhi; Treatment Outcome; Typhoid Fever

Nowadays in Poland, Salmonella typhi (S. typhi) infections are diagnosed rare. Despite the low incidence of typhoid fever, this disorder should be still in our mind. The clinical profiles of typhoid fever are various and atypical manifestation often makes the serious diagnostic problem, in childhood especially. We report herewith a case of typhoid fever in 5 years old boy, manifested as a respiratory tract infection. We present also some basic information on this rare but still serious disorder and on Gram-negative bacilli identified as S. typhi causing the typhoid fever.

Topics: Anti-Bacterial Agents; Cefotaxime; Child, Preschool; Humans; Male; Salmonella typhi; Typhoid Fever

Topics: Adolescent; Anti-Infective Agents; Cefotaxime; Cephalosporins; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Humans; Male; Microbial Sensitivity Tests; Salmonella typhi; Treatment Outcome; Typhoid Fever

The emergence of multi drug-resistant Salmonella typhi (MDRST) in many developing countries including Pakistan, has led to a search for suitable alternatives to conventional therapy. Quinolones have been found to be an effective alternative for the treatment of MDRST, in adults as well as in children.. The efficacy of various therapeutic regimens currently used for the treatment of Typhoid was analysed. Children 1 month to 12 years of age admitted to the Children's Hospital from 1990 to 1993 with fever and Salmonella typhi isolated from blood cultures were included in this retrospective analysis.. The cumulative prevalence of Multiple Drug Resistant Salmonella typhi (MDRST) was 67.2%. Only 32.8% of isolated Salmonella typhi were susceptible to chloramphenicol and amoxicillin. The cumulative cure rate with conventional therapy (chloramphenicol or amoxicillin) was 47.4% and 53.6% children needed a change of therapy. The average hospital stay for the non-responders to conventional therapy was 9.2 days as compared to 7.7 days for the responders. The average hospital stay of the patients treated with a third generation cephalosporin was 12.7 days. Patients treated with ofloxacin, a flouroquinolone drug, did not need a change of therapy. The average hospital stay of the patients treated with flouroquinolones was 6.2 days.. There was a high prevalence of multiple drug resistant typhoid fever in hospitalized children, leading to a high failure rate with conventional therapy. This resulted in frequent change of therapy, delayed defervesence and prolonged hospital stay. The flouroquinolones were found to be the most effective drug against MDRST.

Topics: Amoxicillin; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Chloramphenicol; Drug Resistance, Multiple; Drug Therapy, Combination; Female; Humans; Infant; Infusions, Intravenous; Male; Microbial Sensitivity Tests; Ofloxacin; Pakistan; Prognosis; Retrospective Studies; Salmonella typhi; Treatment Failure; Treatment Outcome; Typhoid Fever

Acute Salmonella typhi meningitis is rare in neonates, mostly reported from developing countries with poor socioeconomic conditions.. A male Caucasian newborn presented with acute Salmonella typhi meningitis at the age of 25 days. His parents had traveled across several African countries under rudimentary hygienic conditions a few months before his birth. Despite early and adapted antibiotic therapy (cefotaxime plus netilmycine), the child developed ischemia in the region of the left sylvian artery.. Salmonella meningitis must be considered while dealing with a sick newborn whose mother has traveled across countries with endemic typhoid.

Topics: Brain Ischemia; Cefotaxime; Cephalosporins; Cerebral Arteries; Cerebral Infarction; Gentamicins; Humans; Infant, Newborn; Male; Meningitis, Bacterial; Netilmicin; Typhoid Fever

A 20-year old man was admitted to hospital with fever and malaise after travel to India. He was soon found to have typhoid fever, caused by a multi-drug resistant Salmonella typhi. According to in-vitro resistance testing he was treated with cefotaxim, but fever and shivering were still present after 7 days of cefotaxim, with liver enzyme disturbances. The physicians caring for him started an extensive search for possible complications of typhoid fever, and they thought of the possibility of an alternative disease to explain the fever. When cefotaxim was stopped all symptoms and signs disappeared. During every medication, drug fever is a possibility. This diagnosis can only be supported by discontinuing the use and if necessary, restarting it (dechallenge and rechallenge).

Topics: Adult; Cefotaxime; Cephalosporins; Diagnosis, Differential; Fever; Humans; Male; Salmonella typhi; Typhoid Fever

Topics: Adult; Cefotaxime; Cephalosporins; Female; Fever; Humans; Male; Salmonella typhi; Typhoid Fever

Emergence of multi-resistant strains of Salmonella typhi is a major problem in treatment of typhoid fever and requires an excessive hospitalization period. Therefore, the present study was carried out to estimate the degree of the resistance of S. typhi strains to various antibiotics such as cefixime. Fifty two strains of Salmonella typhi isolated from patients with typhoid fever and their sensitivity to various antibiotics was determined. MICs of cefixime and chloramphenicol were also determined according to comitee de l'antibiogramme français. Results indicated that 41.9%, 33.9%, 38.7%, 58.1% and 1.6% of isolated strains were resistant to chloramphenicol, co-trimoxazole, ampicillin, tetracycline and gentamycin respectively. About one third (33.9%) of strains showed multiple resistance to the first four mentioned antibiotics. All strains were susceptible to ceftizoxime and cefixime (MICs 1 and less than 1 mcg/ml). It could be concluded that cefixime due to its effectiveness, oral administration and shorter courses of treatment could be the therapy of choice in cases of typhoid fever caused by multiple resistant strains especially when we have a shortage of hospital beds.

Topics: Anti-Bacterial Agents; Cefixime; Cefotaxime; Ceftizoxime; Cephalosporins; Drug Resistance, Microbial; Humans; In Vitro Techniques; Microbial Sensitivity Tests; Salmonella typhi; Typhoid Fever

Multidrug-resistant Salmonella typhi has become a major public health problem. In this study, typhoid fever was diagnosed by isolation of Salmonella typhi from blood or by a positive Widal's reaction in 170 Pakistani children. There were 111 boys (65%) and 59 girls (35%). The average age was 6.2 years; 4 (2%) were less than 1 year old, 78 (46%) were 1 to 5 years old, and 88 (52%) were more than 5 years old. All patients were pretreated with antibiotics. Salmonella typhi was detected by culture in 109 cases (64%), by Widal's test in 84 (49%), and by both in 23 (14%). All 79 isolates that were multidrug resistant were sensitive to ofloxacin, cefotaxime, and ceftriaxone. Clinical features of infections due to resistant S typhi did not differentiate these from other cases of typhoid. Fifty-five infections (70%) due to resistant S typhi were treated with ofloxacin and 24 (30%) with ceftriaxone. Sixteen patients had complications, and all recovered.

Topics: Ampicillin Resistance; Anti-Infective Agents; Cefotaxime; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Chloramphenicol Resistance; Drug Resistance, Multiple; Female; Humans; Infant; Male; Ofloxacin; Pakistan; Salmonella typhi; Trimethoprim Resistance; Typhoid Fever

Increasing prevalence of multidrug-resistant (MDR) Salmonella typhi strains in pediatric cases of typhoid fever and chemotherapy restrictions in children, such as fluoroquinolones, require ongoing clinical evaluations of different antibiotic regimens. Previously reported clinical trials with oral cefixime therapy given as a 12-day regimen (20-30 mg/kg divided twice daily) demonstrated both safety and efficacy. An open trial was undertaken to investigate a short course (8-day) regimen of oral cefixime in an Egyptian public fever hospital. Eighty children were initially enrolled with blood culture confirmation in 60 children. Clinical cure was documented in 57 (95 per cent) with three children requiring a change in antibiotic regimen due to therapeutic failure and one child with culture-confirmed relapsed 21 days post-therapy. All S. typhi isolates were sensitive to cefixime as measured by disk diffusion. Cefixime was well-tolerated with only mild side-effects, including nausea/vomiting (8 per cent) and abdominal cramping with loose stools (6 per cent), which may have been secondary to typhoid fever. Cefixime given in a short 8-day course is safe and effective in the management of MDR typhoid fever in children.

Topics: Adolescent; Anti-Bacterial Agents; Cefixime; Cefotaxime; Child; Child, Preschool; Drug Resistance, Microbial; Drug Resistance, Multiple; Egypt; Female; Humans; Male; Salmonella typhi; Sepsis; Treatment Outcome; Typhoid Fever

Topics: Cefotaxime; Child; Child, Preschool; Drug Resistance, Multiple; Female; Humans; Infant; Injections, Intravenous; Male; Typhoid Fever

Salmonella infections in man can be divided in five clinical groups: enteric fever, septicaemia without localization, focal disease, gastroenteritis and the carrier state. Salmonella typhi is mostly associated with enteric fever and the carrier state. Bone infections due to S. typhi have been reported relatively seldom. They usually occur as the result of metastatic spread during septicaemia or, more rarely, after direct inoculation. Two patients with S. typhi osteomyelitis of the forearm without evidence of a primary infection or direct inoculation are presented here.

Topics: Adult; Cefotaxime; Forearm; Humans; Male; Ofloxacin; Osteomyelitis; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever; Wrist

Cefixime in a dose 20 mg/kg/day, orally, divided into two doses 12 h apart for a minimum of 12 days, was administered to 50 children with proven S. typhi septicaemia. Forty four of the patients were infected with strains of S. typhi resistant to multiple antibiotics including chloramphenicol, ampicillin and trimethoprim-sulfamethoxazole. All patients responded rapidly to treatment and were cured clinically and bacteriologically. Fever subsided within a mean of 5.3 days (range 3-8 days). Only two of the 50 patients treated relapsed during the 8 week follow-up period. No serious adverse reactions attributable to the drug were observed. Cefixime proved to be an effective oral drug in this open treatment trial and was associated with minimal side effects. It may provide a therapeutic alternative to the treatment of Salmonella infection with organisms multi-resistant to the standard drug regimens. Its oral formulation may provide an efficient alternative to parenteral therapy in less severely ill patients who can tolerate oral feeding.

Topics: Adolescent; Anti-Bacterial Agents; Cefixime; Cefotaxime; Child; Child, Preschool; Drug Resistance, Microbial; Female; Humans; Male; Microbial Sensitivity Tests; Salmonella typhi; Typhoid Fever

Topics: Adult; Cefotaxime; Chloramphenicol Resistance; Drug Resistance, Microbial; Gentamicins; Humans; Male; Salmonella typhi; Typhoid Fever

Enteric fever caused by Salmonella typhi resistant to all the standard first-line antibiotics is emerging as a major problem in developing countries. Fifteen such culture-proven cases were treated with ceftriaxone (6), cefotaxime (5) or ciprofloxacin (4). The earliest defervescence occurred with ceftriaxone (mean 3.3 days). Clinical cures were obtained with all three drugs with only one child having a relapse. Ciprofloxacin, by virtue of its cost and an oral route of administration, is the ideal choice in a developing country.

Topics: Cefotaxime; Ceftriaxone; Child; Child, Preschool; Ciprofloxacin; Drug Resistance, Microbial; Female; Follow-Up Studies; Humans; Infant; Male; Salmonella typhi; Typhoid Fever

Treatment of children with infections caused by Salmonella typhi strains resistant to the commonly used oral antimicrobials is a special problem. As children cannot be treated with quinolones, there is no form of oral therapy. Third generation cephalosporins, which have been shown to be effective against typhoid caused by ampicillin sensitive strains of S. typhi were effective against typhoid caused by ampicillin, chloramphenicol and sulfamethoxazole/trimethoprim-resistant strains. We treated 28 children with ceftriaxone and 8 with cefotaxime. We found ceftriaxone to be more effective than cefotaxime with significantly lower relapse rate. Antibiotic therapy of 19 other children, initially treated in a similar manner, was altered for ease of therapy or due to poor response to therapy. The high cost of this parenteral therapy and the problems in its delivery point to the need for safe, effective oral therapy.

Topics: Adolescent; Ampicillin Resistance; Aztreonam; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Chloramphenicol Resistance; Drug Resistance, Microbial; Humans; Infant; Infant, Newborn; Ofloxacin; Salmonella typhi; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Topics: Ampicillin; Cefotaxime; Child; Child, Preschool; Chloramphenicol; Chloramphenicol Resistance; Ciprofloxacin; Drug Resistance, Microbial; Female; Humans; India; Male; Salmonella typhi; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Following a brief review of the main bacteriological and pharmacokinetic properties of ceftriaxone, the authors present a therapeutic evaluation of this new cephalosporin antibiotic. The effects of ceftriaxone in severe infections, such as septicaemia, bacterial meningitis, urinary tract infections, typhoid, bone infections and sexually transmitted diseases, are described on the basis of recent publications. Mention is also made of the adverse reactions to, and benign side-effects of the drug. Finally, the advantages of ceftriaxone in the treatment of some infections are envisaged: the single daily dose and short therapeutic courses may modify therapeutic habits and exert a beneficial effect on costs in some cases.

Topics: Bacterial Infections; Cefotaxime; Ceftriaxone; Humans; Meningitis; Respiratory Tract Infections; Sepsis; Sexually Transmitted Diseases; Typhoid Fever; Urinary Tract Infections

Topics: Adult; Aged; Ampicillin; Carrier State; Cefotaxime; Cephalosporins; Cholelithiasis; Female; Humans; Middle Aged; Paratyphoid Fever; Typhoid Fever

Topics: Adult; Aged; Cefotaxime; Cephalosporins; Humans; Male; Middle Aged; Sepsis; Typhoid Fever