Therapy Of Typhoid Fever Research Articles

Cost-Effectiveness Analysis Of Ceftriaxon And Chloramphenicol In Pediatric Patients With Tyfoid Fever In Hospital X, Jombang Regency

Typhoid fever is a disease caused by infection by the bacterium Salmonella typhi which infects the human digestive tract. Typhoid fever is spread all over the world, it is estimated that the incidence is between 11-21 million cases per year with a death rate reaching 215,000 (Rampengan, 2016). The main treatment for typhoid fever is by administering antibiotics and also bed rest. The first antibiotic administered as therapy for typhoid fever was chloramphenicol. But along with technological developments which affect the drug development as well, many new antibiotics for typhoid fever have been discovered, such as ceftriaxone antibiotic (Rampengan, 2016). This study aims to find out a more cost-effective therapy for the treatment in pediatric patients with typhoid fever in Jombang Public Hospital. This study used a cross-sectional research design with retrospective data collection. The samples in this study were 31 pediatric patients with typhoid fever with 16 patients were administering ceftriaxone injection antibiotic therapy and 15 patients were administering chloramphenicol injection antibiotic therapy. Data were identified using the cost-effectiveness analysis of ACER and ICER calculations with the long-of-stay therapy outcome. The results showed that ceftriaxone had a lower ACER value of IDR 1,687,279.88 with an effectiveness of 100%, compared to the ACER of chloramphenicol which had value of IDR 2,336,405.29 with an effectiveness of 86.67%. From these results it was concluded that ceftriaxone is more cost-effective than chloramphenicol.

165. Emergence of Extensively Drug-Resistant Salmonella enterica Serotype Typhi Infections—United States, 2008–2020

BackgroundTyphoid fever, caused by Salmonella Typhi, is fatal in 12%–30% of patients not treated with appropriate antibiotics. In 2016, a large outbreak of extensively drug-resistant (XDR) Typhi infections began in Pakistan with cases reported globally, including the United States. In 2021, the Centers for Disease Control and Prevention (CDC) issued a health advisory on XDR infections among U.S. residents without international travel. We describe resistance of Typhi infections diagnosed in the United States to help guide treatment decisions. MethodsTyphoid fever is a nationally notifiable disease. Health departments report cases to CDC through the National Typhoid and Paratyphoid Fever Surveillance system. Isolates are submitted to the National Antimicrobial Resistance Monitoring System for antimicrobial susceptibility testing (AST) using broth microdilution. AST results are categorized by Clinical and Laboratory Standards Institute criteria. We defined XDR as resistant to ceftriaxone, ampicillin, chloramphenicol, and co-trimoxazole, and nonsusceptible to ciprofloxacin.ResultsDuring 2008–2019, of 4,637 Typhi isolates, 52 (1%) were ceftriaxone resistant (axo-R); 71% were ciprofloxacin nonsusceptible, 1 azithromycin resistant (azm-R), and none meropenem resistant. XDR was first detected in 2018, in 2% of 474 isolates and increased to 7% of 535 in 2019. Of the 52 axo-R isolates, 46 were XDR, of which 45 were from travelers to Pakistan, and one from a non-traveler; 6 were not XDR, of which 4 were linked to travel to Iraq. In preliminary 2020 reports, 23 isolates were XDR; 14 were from travelers to Pakistan, 8 from non-travelers, and 1 from someone with unknown travel status. Among those with XDR infection, median age was 11 years (range 1–62), 54% were female, and 62% were from 6 states. ConclusionCeftriaxone-resistant Typhi infections, mostly XDR, are increasing. Clinicians should ask patients with suspected Typhi infections about travel and adjust treatment based on susceptibility results. Carbapenem, azithromycin, or both may be considered for empiric therapy of typhoid fever among travelers to Pakistan or Iraq and in uncommon instances when persons report no international travel. Ceftriaxone is an empiric therapy option for travelers to countries other than Pakistan and Iraq. Disclosures All Authors: No reported disclosures

Gallbladder sludge associated with ceftriaxone therapy for typhoid fever in Nigerian children: A case series

Ceftriaxone is a third-generation cephalosporin with a wide spectrum of activity against both gram-negative and gram-positive organisms. Ceftriaxone has proven efficacy against severe and difficult-to-treat community-acquired infections including typhoid fever and other sepsis syndromes caused by multi-drug resistant organisms. Several studies including prospective studies exist in the literature that described the accumulation of sonographically demonstrable sludge (or precipitates) in the gallbladder and sometimes in the urinary tract. The accumulation of sludge occurs during therapy for severe infections in some children identified with certain predisposing factors. The condition is often asymptomatic but might be associated with clinical features that could mimic disease progression in patients with intra-abdominal manifestations of infection such as typhoid fever. Five Nigerian children aged between 4 and 11 years developed demonstrable gallbladder sludge (precipitate) while on treatment for typhoid fever with ceftriaxone. Three of the children manifested clinical features suggestive of gallbladder precipitate accumulation following commencement of the antibiotic, while the other two did not. Ceftriaxone therapy was continued to completion in all the cases along with conservative management. Four of the children recovered and had resolution of the sludge, while the fifth died of multi-organ failure after surgery for intestinal perforation. Although several studies exist in the literature regarding this condition, our search using Medline and Google Scholar did not identify such reports from children in Nigeria or sub-Saharan Africa. The cases are presented to create awareness on the possibility of occurrence of a drug-induced biliary precipitate formation in children.

Salmonella enterica serovar Typhi de sensibilité diminuée à la ciprofloxacine

The use of fluoroquinolone (FQ) as first line therapy for typhoid fever should be reconsidered because of the emergence of Salmonella Typhi and Paratyphi A strains with decreased susceptibility to FQ, mainly from Asia. Relapse can occur when ciprofloxacin MIC is over 0.12 mg/l, as illustrated by our case report. Azithromycin can be used successfully for patients infected with reduced ciprofloxacin susceptibility isolates. Literature review led us to suggest a new therapeutic strategy for uncomplicated typhoid fever, the antibiotic was chosen according to nalidixic acid susceptibility and ciprofloxacin MIC of the strain. High-dose intravenous ceftriaxone (4 g per day) is always efficient in first line therapy. Depending on FQ susceptibility testing results, it is relayed by oral therapy with a FQ (ciprofloxacin 500 mg bid for 7 days) if the isolate has maintained susceptibility, or azithromycin (1 g first day and 500 mg per day, 7 days) if the isolate is resistant to nalidixic acid or has a ciprofloxacin MIC superior to 0.12 mg/l.

Emergence of multidrug-resistant Salmonella enterica serotype Typhi with decreased ciprofloxacin susceptibility in Bangladesh

During 1989-2002, we studied the antimicrobial resistance of 3928 blood culture isolates of Salmonella enterica serotype Typhi (S. Typhi) in Dhaka, Bangladesh. Overall 32% (1270) of the strains were multidrug-resistant (MDR, resistant to chloramphenicol, ampicillin and trimethoprim-sulphamethoxazole); first detected in 1990 (rate of 8%), increased in 1994 (44%), declined in 1996 (22%, P<0.01 compared to 1994) and re-emerged in 2001 (36%) and 2002 (42%, P<0.01 compared to 1996). An increased MIC of ciprofloxacin (0.25 microg/ml) indicating decreased susceptibility to ciprofloxacin was detected in 24 (18.2%) out of 132 randomly selected strains during 1990-2002; more frequently in MDR than susceptible strains (46.3% vs. 5.5%, P<0.001), and the proportion of them rose to 47% in 2002 from 8% in 2000 (P<0.01). Ciprofloxacin (5 microg) disk diffusion zone diameters of < or =24 mm as break-point had 98% sensitivity and 100% specificity when compared with a ciprofloxacin MIC of 0.25 microg/ml as break-point for decreased susceptibility; being a useful and easy screen test. All strains were susceptible to ceftriaxone. The emergence of MDR S. Typhi with decreased ciprofloxacin susceptibility will further complicate the therapy of typhoid fever because of the lack of optimum treatment guidelines.

Short Course Quinolone Therapy of Typhoid Fever in Developing Countries

A 14-day course of chloramphenicol or cotrimoxazole has been standard chemotherapy for uncomplicated salmonella enteric fever for several decades. The new fluoroquinolones show in vitro minimum inhibitory concentrations against Salmonella spp. ranging from 0.003 to 0.25 mg/L. Early clinical trials with 14-day courses of ciprofloxacin, ofloxacin or pefloxacin given orally achieved cure rates of 100%. Subsequent trials with 7- to 10-day courses of these fluoroquinolones also consistently yielded cure rates of 100%, whereas more recent trials of 3- to 6-day courses reported preliminary cure rates of 67 to 99%. At present, it appears that fluoroquinolone therapy for at least 7 days is a cost-effective substitute for the standard drugs in uncomplicated salmonella infections resistant to cotrimoxazole and/or chloramphenicol. The use of shorter 3- to 6-day courses of fluoroquinolone therapy needs further study, in view of lower cure rates reported in preliminary clinical trials.

Fluoroquinolones versus chloramphenicol in the therapy of typhoid fever: A clinical and microbiological study

The purpose of this study was to evaluate the efficacy and safety of five fluoroquinolones: ofloxacin, pefloxacin, ciprofloxacin, enoxacin, and norfloxacin, when compared with chloramphenicol in the therapy of typhoid fever. One hundred fifty-six patients suffering from Salmonella typhi infection entered this open study. They were divided into six groups and randomly assigned. A wide microbiologic study was conducted to support the thesis that isolates of S typhi showing identical serological and biochemical characteristics, were a single clone, as a recent genetic work has proven. At the conclusion of treatment, the enoxacin and norfloxacin groups reported some nonresponders and patients with chronic enteric carrier state. Ofloxacin and ciprofloxacin were more effective than chloramphenicol. No relapses or chronic enteric carrier states were reported in these two groups or the pefloxacin group but ofloxacin was more effective, with milder side effects.

An Outbreak of Multiresistant Salmonella typhi in South Africa

Typhoid fever caused by Salmonella typhi remains endemic to many parts of South Africa, including Natal and KwaZulu, Northern Transvaal and the Transkei. Until recently, the majority of S. typhi isolates from South Africa have remained susceptible to ampicillin/amoxycillin and chloramphenicol, and only three cases of typhoid due to multi-antibiotic resistant strains of S. typhi have been documented. Ampicillin/amoxycillin and chloramphenicol are, therefore, still recommended as first line therapy for patients with typhoid fever in this country. We describe a cluster of six cases of typhoid caused by S. typhi that was resistant to ampicillin, chloramphenicol and trimethoprim-sulphamethoxazole. All these patients presented over a 3-month period; the patients were from three adjacent districts in the Northern Natal area of South Africa. The high rate of intestinal perforation (two of six) was a direct consequence of inappropriate antibiotic treatment. Failure of surgical intervention, renal impairment as well as delay in starting appropriate antibiotic treatment were factors contributing to the high mortality (three of six). The good clinical outcome in the remaining three patients probably resulted from treatment with appropriate antibiotics; however, mild disease in two of these patients may have been a contributing factor. All isolates showed high minimal inhibitory concentrations (MIC) of greater than or equal to 256 micrograms/ml to ampicillin, chloramphenicol and trimethoprim-sulphamethoxazole. The isolates were all highly sensitive to the third generation cephalosporins (MIC less than or equal to 0.06 micrograms/ml) and quinolones (MIC less than or equal to 0.03 micrograms/ml). Conjugation studies suggest a genetic transfer of resistance, probably plasmid mediated. The presence of beta-lactamase and chloramphenicol acetyl transferase enzymes in all six isolates tested would account for the resistance to ampicillin and chloramphenicol respectively. The transfer of such plasmids to erstwhile sensitive strains could conceivably occur in this typhoid-endemic area, where sanitary conditions are poor and living conditions crowded, thus further exacerbating the problem. It is recommended that in areas where such multiresistant strains are encountered, the third generation cephalosporins or quinolones be used as empiric therapy for typhoid fever.

Chloramphenicol Therapy of Typhoid Fever and its Relationship to Hepatic Dysfunction

Chloramphenicol Therapy of Typhoid Fever and its Relationship to Hepatic Dysfunction

Ciprofloxacin is now recommended for typhoid fever therapy in the UK

Ciprofloxacin is now recommended for typhoid fever therapy in the UK

Successful Aztreonam Treatment of Acute Typhoid Fever after Chloramphenicol Failure

Aztreonam treatment was successful in 4 cases of typhoid fever. The patients were seriously ill with growth of Salmonella typhi in blood cultures despite treatment with chloramphenicol. Aztreonam appears to be a useful alternative to standard therapy of typhoid fever.

Furazolidone and Chloramphenicol for Treatment of Typhoid Fever

Seventy-one adults who were hospitalized between March 1985 and March 1987 were entered into a randomized, double-blind study to compare the efficacy and safety of furazolidone and chloramphenicol in therapy for typhoid fever. Patients received chloramphenicol capsules (total daily dosage, 2 g) plus placebo tablets for furazolidone tablets (total daily dosage, 800 mg) plus placebo capsules for 14 days. Seven patients were excluded from the analysis of efficacy because blood, bile, or bone marrow cultures at admission failed to demonstrate the presence of Salmonella typhi. Four additional patients were excluded because of intercurrent illness or failure to return for follow-up visits. Cure was achieved in 31 (97%) of 32 chloramphenicol recipients and 24 (86%) of 28 furazolidone recipients. In the chloramphenicol group, one patient experienced moderate sideroblastic anemia, and another experienced moderate neutropenia. Both adverse reactions resolved spontaneously within 7 days. Mild gastritis was reported by two patients who received furazolidone and one who received chloramphenicol. This study has demonstrated that furazolidone is an effective and safe alternative to chloramphenicol for the treatment of typhoid fever in adults.

On the effect of synthomycin on the cardiovascular system in typhoid fever

The greatest modern achievement in typhoid fever therapy was the use of synthomycin and levomycetin. In this way, as shown by V. N. Orekhovich, G., P. Rudnev, A. F. Bilibin and many others, it is possible to achieve rapid improvement of the general state of patients, the relief of fever and reduction of the period of the disease. But the question of the cardiovascular system condition, the frequency of brucellosis myocarditis and subsequent changes of cardiovascular activity during synthomycin treatment has not been specifically studied. We made an attempt to clarify the effect of synthomycin on the cardiovascular system during typhoid fever. For this purpose we compared changes of the cardiovascular system in 50 patients with typhoid fever treated by usual methods and in 54 patients who received, along with symptomatic therapy, treatment with synthomycin.

The Therapy of Typhoid Fever

The Therapy of Typhoid Fever

Treatment of typhoid fever. II. Control of clinical manifestations with cortisone.

Excerpt Despite the obvious benefits of chloramphenicol therapy in typhoid fever,1, 2there are several problems in this disease which remain to be solved: (1) The present chloramphenicol regimens d...

Antibiotic Therapy of Typhoid Fever

Antibiotic Therapy of Typhoid Fever

THE NATURE AND USES OF LYSED TYPHOID VACCINES

Up to a few years ago, the therapy for typhoid fever wandered in a maze of vague empiricism. To the person's bodily resistance, almost unhelped, was entrusted the task of aiding his recovery. At best, the only available aid lay in an irrational therapy, or equally irrational dietetics. The first attempts at chemotherapy and serotherapy were such failures that, after short trials, these were abandoned so that medical men were led to renounce all attempts at specific therapy. Then came the advent of vaccinotherapy, an advent which reopened the subject. I shall discuss the vaccine therapy for typhoid and paratyphoid fever, with special emphasis on lysed vaccines. From Di Cristina's 1 first experiments in twenty-one cases of typhoid fever, made in 1916, and my own which followed during the same year, 2 in which I studied forty-six cases of typhoid and paratyphoid fever, up to the present time, many experiments

Treatment of typhoid fever with barium chloride

Typhoid fever, according to the duration of its course and the possibility of complications and a number of surprises, belongs to the category of those diseases where the doctor at the bedside is in the same position as those around him - from the moment of setting the diagnosis he cannot, even approximately, say anything about the duration of the disease itself or about the nature of its course, and all his struggle with typhoid is limited to symptomatic therapy. For this reason the efforts of the medical world have long been directed toward finding a specific treatment for the disease. Sero- and vaccine therapy of typhoid fever, however, has not yet given tangible practical results, because, although some authors point to shortening the duration of the disease and lowering the mortality rate, I think that other factors may play a role here, such as the nature of the typhoid epidemic, the degree of hospitalization of patients, etc. Leaving aside the issue of sero- and vaccine therapy, as it is not within our scope, I would like to touch only the drug treatment of typhoid fever. Here, too, the situation is very sad.

A Study of the Vaccine Therapy of Typhoid Fever

A Study of the Vaccine Therapy of Typhoid Fever

Comparative assessment of typhoid fever therapy in children's practice

Abstracts. Diseases of children.Ya.T. Neishtab. Comparative assessment of typhoid fever therapyin children's practice. Medical newspaper 1901, no. 31.On 23 cases of typhoid fever in children at the age of 8 months. up to 15 liters. The author carried out three methods of treatment: antipyretic - pharmaceutical (antipyrine), water treatment and expectant or symptomatic. The first method was used to treat 5 children aged 4 to 12 years; antipyrine was given regularly in doses from o, s to i, o 3 times a day. According to the author's observations, antipyrine greatly lowers t in the first days of the illness and during the weakening of the fever (on the 3rd week and very weakly with the tension of the painful process; the heart becomes more frequent and the pulse is soft, jumping up and slightly resistant (on prolonged action) scarlet rash, sometimes draining.