Study on the efficacy of ceftriaxone versus azithromycin for the treatment of uncomplicated enteric fever among the patients admitted in a tertiary level hospital
DOI:
https://doi.org/10.18203/2319-2003.ijbcp20214883Keywords:
Typhoid fever, Paratyphoid fever, Ceftriaxone, AzithromycinAbstract
Background: Typhoid fever is a severe debilitating and potentially life threating illness. In Bangladesh, typhoid fever is a round the year problem which sometimes take epidemic proportions. The reasons behind such occurrences are unsafe water supply, defective sewage system and unhygienic food handling practice. This study aimed to compare the efficacy of ceftriaxone and azithromycin in the treatment of uncomplicated enteric fever.
Methods: An observational study was conducted at the department of pharmacology in Dhaka medical college, Dhaka, Bangladesh. Data were collected from blood culture positive patients for Salmonella typhi and Salmonella paratyphi, who admitted in the Dhaka medical college and hospital, Dhaka during the period of July 2015 to June 2016. Data was collected by using a structured questioner, face to face interview, physical examination and investigation reports. Patients were hospitalized during the entire treatment period and at admission evaluation was made by history and physical examination in a structured format. Subjects ware asked regarding changes in symptoms and possible adverse effects of the study drugs. All patients were asked to return two weeks after completion of treatment for follow up. Blood culture of Salmonella typhi or Salmonella paratyphi were done in all cases. Total 91 patients were culture positive for either S. typhi or S. paratyphi which were finally studied.
Results: During the study period out of 91 patients, 51 were receiving ceftriaxone and 40 were receiving azithromycin. Clinical cure was achieved in 46 patients (90%) of ceftriaxone group and in 31 patients (78%) in the azithromycin group. There were no significant differences of clinical cure between both treatment groups (p>0.05). Mean fever clearance time in ceftriaxone group was 3±1.4 days and was 4±1.6 days for azithromycin group. Difference in fever clearance time was statistically significant (p<0.05). No clinical relapses were detected in any study subject. No major side effects of both drugs occurred in any subject.
Conclusions: These results indicated that both ceftriaxone and azithromycin were effective against enteric fever caused by sensitive organisms and multi drug resistant S. typhi and S. paratyphi. It is concluded that ceftriaxone is more effective and can be a convenient alternative for the treatment of enteric fever, especially in developing countries like us where medical resources are scarce.
Metrics
References
Connor BA, Schwartz E. Typhoid and paratyphoid fever in travelers. Lancet Infect Dis. 2005;5:623-8.
Roy RN, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. 4th edition. India: Jaypee Brothers Medical Publishers. 2013;230.
Dutta TK, Beeresha, Ghotekar LH. Atypical manifestations of typhoid fever. J Postgrad Med. 2001;47(4):248-51.
Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ. Typhoid fever. N Engl J Med 2002;347(22):1770-82.
Rahman AKMM, Ahmad M, Begum RS, Hossain MZ, Hoque SA, Matin A et al. Prevalence of typhoid fever among the children in a semi urban area of Bangladesh. J Dhaka Med Coll. 2011;20(1):37-43.
Rahman AKMM, Ahmad M, Begum RS, Ghosh AK, Hossain MZ. Multidrug resistant typhoid fever in children: A review. J Dhaka Med Coll. 2008;17(2):121-6.
Ochiai RL, Acosta CJ, Danovaro-Holliday MC, Baiqing D, Bhattacharya SK, Agtini MD et al. A study of typhoid fever in five Asian countries: disease burden and implications for controls. Bull World Health Org. 2008;86:260-8.
Pegues D. Enteric fever. Infectious Disease Advisor 2017, 2013. Available from: https://www.infectiousdiseaseadvisor.com/home/decision-support-in-medicine/infectious-diseases/enteric-fever/
Kanungo R. Ananthanarayan and Paniker's Textbook of Microbiology. 10th edition. India: The Orient Blackswan. 2017;302.
Greenwood D, Barer M, Slack R, Irving W. Medical Microbiology. 18th edition. UK: Churchill Livingstone Elsevier. 2012;270.
Antimicrobial Resistance: Global Report on Surveillance. World Health Organization 2014. P 24. Available at: https://apps.who.int/iris/bitstream/handle/10665/112642/9789241564748_eng.pdf. Accessed on 25 April, 2021.
Brusch JL, Garvey T, Corales R, Schmitt SK, Talavera F, Brown RB et al. Typhoid fever. MedScape. 2019. Available at: https://emedicine.medscape.com/article/231135-print. Accessed on 25 April, 2021.
Sreenivasa B, Manjunatha B, Joseph N. To compare the effectiveness of oral azithromycin versus intravenous ceftriaxone for treating uncomplicated enteric fever. Indian J Child Health. 2016;3(3):230-3.
Neu HC, Meropol NJ, Fu KP. Antibacterial Activity of Ceftriaxone (Ro 13-9904), a β-Lactamase-Stable Cephalosporin. Antimicro agents chemotherapy. 1981;19(3):414-23.
Patel IH, Chen S, Parsonnet M, Hackman MR, Brooks MA, Konikoff J et al. Pharmacokinetics of Ceftriaxone in Humans. Antimicro agents chemotherapy. 1981;20(5):634-41.
Schaad UB, Stoeckel K. Single-Dose Pharmacokinetics of Ceftriaxone in Infants and Young Children. Antimicro agents chemotherapy. 1982;21(2):248-53.
Chowdhury MAJ, Shumy F, Anam AM, Chowdhury MK. Current status of typhoid fever: a review. Bangladesh Med J. 2014;43(2):106-11.
Mutanabbi M, Islam KA, Helal MA, Mamun HA, Quader M, Ahmed S. Retrospective analysis of 52 cases of enteric fever in a tertiary care hospital in Dhaka city. Bangl J Med. 2010;21:71-3.
Rahman M, Ahmed ASM NU, Iqbal J, Mamun AA, Hossain N, Islam A. Socio-Demographic Factors Affecting the Prevalence of Enteric Fever: A Study in a Tertiary Care Hospital, Dhaka, Bangladesh. Scholars J Appl Med Sci. 2020;8(8):1927-31.
Banu A, Rahman MJ, Suza-ud-doula A, Majumder B, Mostakim MA, Rahman M et al. Clinical profile of typhoid fever in children in northern areas of Bangladesh. Dinajpur Med Col J. 2016;9(1):53-8.
Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J. Harrison’s Principles of Internal Medicine. 20th edition. USA: The McGraw-Hill Education. 2018;1175.
Islam S, Rahman H, Karim B, Khan RH. Clinical Presentation of Typhoid Fever. Ibrahim Card Med J. 2011;1(2):40-4.
Jyoti D, Gupta NP, Vijay C, Agarwal A, Kumari S. Clinical and laboratory profile of typhoid fever in children in North Bihar. Int J Health Clin Res. 2020;3(12S):218-23.
Saha SK, Saha S, Sayeed KMI, Saha S, Islam S, Rahaman A et al. Hospitalization of Pediatric Enteric Fever Cases, Dhaka, Bangladesh, 2017-2019: Incidence and Risk Factors. Clin Infectious Dise. 2020;71(S3):196-204.
Rahat F, Ghosh NK, Iman K, Khanam M, Sultana A, Haque F. Clinico-laboratory Profile of Enteric Fever and Antibiotic Sensitivity Pattern in Hospitalized Children. Bangl J Child Health. 2018;42(2):54-7.