A Single Blind Comparative Randomized Non-Inferior Multicenter Study for Efficacy and Safety of Levofloxacin versus Ciprofloxacin in the Treatment of Uncomplicated Typhoid Fever

Ronald Nelwan,Khie Chen Lie,Diana Paramita,Gatoet Ismanoe,Suharto &Nbsp,Eddy Suwandoyo,Primal Sudjana,Hadi Yusuf,Munirah Said,Halim Mubin,Djoni Djunaedi,Suharyo Hadisaputro,Nasronudin &Nbsp

doi:10.4236/aim.2013.31019

Abstract

Ciprofloxacin is currently the drug of choice for typhoid fever, but Salmonella typhi resistance to ciprofloxacin is increasing, while levofloxacin has been shown to be very effective in a few open studies. This study aimed to compare the efficacy, and safety of levofloxacin and ciprofloxacin for typhoid fever. From 110 patients with confirmed typhoid fever, 54 patients received oral levofloxacin 500 mg once daily with one drop out, while 56 received ciprofloxacin 500 mg twice daily for 7 days with two drop outs. Defervescence of fever was achieved on an average of 3 days after initiating levofloxacin and 5 days after starting ciprofloxacin and one microbiologically non confirmed typhoid fever relapse occurred in the levofloxacin group while two relapses with positive Salmonella microorganism occurred in the ciprofloxacin group. No carrier of Salmonella typhi was found in both groups at day 30. Adverse reactions were more pronounced in the ciprofloxacin group compared to the levofloxacin group. In conclusion, oral levofloxacin 500 mg once daily for one week showed faster fever clearance compared to ciprofloxacin 500 mg twice daily in typhoid fever in Indonesia, and less adverse reactions occurred with levofloxacin compared to ciprofloxacin. This electronic document is a “live” template. The various components of your paper (title, text, heads, etc.) are already defined on the style sheet, as illustrated by the portions given in this document.

Highlights

Typhoid fever is still a big threat to the communities in many developing countries; it contributes to acute morbidity and mortality [1]
Defervescence of fever was achieved on an average of 3 days after initiating levofloxacin and 5 days after starting ciprofloxacin and one microbiologically non confirmed typhoid fever relapse occurred in the levofloxacin group while two relapses with positive Salmonella microorganism occurred in the ciprofloxacin group
It was not before long that levofloxacin the stereoisomer of ofloxacin with proven excellent antimicrobacterial activity in vitro againt S. typhi and excellent propertiesfor entering body fluids and organs and even cellular components harbouring the S. typhi bacteria could be recognized as probably an excellent alternative for treatment of typhoid fever [15,16]

Summary

Introduction

Typhoid fever is still a big threat to the communities in many developing countries; it contributes to acute morbidity and mortality [1]. The drug of choice used around the world at this moment is ciprofloxacin that has emerged as an excellent alternative for treatment of typhoid fever [3]. As is nowadays acknowledged, there is a rise in ciprofloxacin resistant Salmonella typhi strains with perhaps more unfavorable outcomes in duration of morbidity and in causing mortality [4,5,6]. In Indonesia, as early as 1996, a case of clinical failure due to resistance of Salmonella typhi to ciprofloxacin was experienced and reported [7]. Even an appeal has been made to reconsider ciprofloxacin to be used for typhoid fever [8].

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