The Use of Ceftriaxone Compared to Chloramphenicol in Typhoid Fever Treatment: an Evidence Based Case Report

Abstract

Typhoid fever is a disease caused by the gram-negative bacterium Salmonella typhi. Since its introduction in 1949, chloramphenicol for decades become a first-line treatment of typhoid fever. Until now, chloramphenicol is still the first line treatment of typhoid fever in rural areas in Indonesia, especially due to its low cost. However, in addition to the problem of bacterial resistance, chloramphenicol is known to cause side effect such as bone marrow suppression. Right now many other antibiotics are used as regimens for treatment of typhoid fever, one of which is ceftriaxone. This report is created to answer the clinical question whether ceftriaxone is more effective compared to chloramphenicol as first-line treatment of typhoid fever. Structured search was performed on PubMed, EBSCO, and ScienceDirect and after a screening process and appraisal using criteria from Center of Evidence Based Medicine at Oxford University, three articles were selected. Two of the three articles demonstrate higher effectiveness of chloramphenicol in term of defervescence rate (P = 0.35 and P > 0.05). On the other hand, the third article shows higher effectiveness of ceftriaxone in term of defervescence rate (P = 0.0001). The conclusion drawn is that ceftriaxone showed better effectiveness in the treatment of typhoid fever compared to chloramphenicol.