scholarly journals Study on the efficacy of ceftriaxone versus azithromycin for the treatment of uncomplicated enteric fever among the patients admitted in a tertiary level hospital

Author(s):  
Sougata Mitra ◽  
Masuma Khanam ◽  
M. Iqbal Hossain ◽  
Rukhsana Quadir

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.

2009 ◽  
Vol 3 (1) ◽  
pp. 10-13 ◽  
Author(s):  
Zohra Begum ◽  
Md Akram Hossain ◽  
AKM Shamsuzzaman ◽  
Md Monjurul Ahsan ◽  
AKM Musa ◽  
...  

Typhoid fever still continues to be a major public health problem, particularly in many developing countries. A simple, reliable, affordable and rapid diagnostic test has been a long-felt need of the clinicians. We, therefore, prospectively evaluated the sensitivity and specificity of Typhidot (IgM), a serological test to identify IgM antibodies against Salmonella typhi. The study was carried out in the department of Microbiology, Mymensingh Medical College, Mymensingh between June, 2006 and July, 2007, on a total of 100 samples from clinically suspected patients to have typhoid fever. Blood culture as well as Typhidot test were performed for each of the cases. Out of 100 clinically diagnosed typhoid fever, 14 were blood culture positive for S. typhi and 73 were Typhidot (IgM) positive. Among 14 culture positive cases, 13 (92.85%) were Typhidot (IgM) positive. The test was also positive in 04 (20%) out of 20 febrile controls. None of the healthy controls was positive by Typhidot (IgM). The sensitivity, specificity, positive predictive value and negative predictive value of the test using blood culture as gold standard were 92.85%, 90.00%, 76.47% and 97.29% respectively for typhoid fever. Typhidot (IgM) test is rapid, easy to perform and reliable test for diagnosing typhoid fever, and useful for small, less equipped laboratories as well as for the laboratories with better facilities. Key words: Typhoid fever, Salmonella typhi, Typhidot (IgM) test   doi: 10.3329/bjmm.v3i1.2964 Bangladesh J Med Microbiol 2009; 03 (01): 10-13


2020 ◽  
Vol 33 (2) ◽  
pp. 10-14
Author(s):  
Md Azizul Haque ◽  
Laila Shamima Sharmin ◽  
KM Faisal Alam ◽  
Md Mohimanul Hoque ◽  
M Morsed Zaman Miah ◽  
...  

Typhoid and paratyphoid fevers, collectively known as enteric fever, is caused by Salmonella enterica subspecies serovars Typhi and Paratyphi A, B and C. Despite this declining global trend, enteric fever is still considered to be a major public health hazard in Bangladesh and other developing countries due to poor sanitation, inadequate food safety measures and poor personal hygiene. In Bangladesh, the incidence of typhoid fever was reported to be 200 episodes per 100,000 person-years during 2003–2004. Multidrug-resistant (resistance to the first-line antimicrobials ampicillin, cotrimoxazole, and chloramphenicol) strains of S. Typhi and S. Paratyphi are on the rise globally and even cases of extensively drug-resistant (XDR) typhoid cases resistant to chloramphenicol, ampicillin, trimethoprim-sulfamethoxazole, third generation cephalosporins and fluoroquinolones are being reported from many corners of the world. This descriptive, observational study was carried out in Rajshahi Medical College Hospital Hospital, Rajshahi, Bangladesh from July 2017 to June 2019. Antibiotic sensitivity pattern of total 76 cases of enteric fever due to Salmonella Typhi were studied. Blood culture was carried out by BACT ALERT-3D, Automated blood culture analyzer from BioMeriuex SA, France Patented FAN Plus method. Based on the minimum inhibitory concentration (MIC), the organism was categorized as sensitive, intermediate, and resistant against the respective antibiotics as per Clinical and Laboratory Standards Institute (CLSI) criteria. We are reporting antibiotic sensitivity and resistant patterns of S. Typhi documented in Rajshahi Medical College Hospital, a large tertiary care hospital in Northern Bangladesh. TAJ 2020; 33(2): 10-14


Author(s):  
Shetty Jeevan

Objective: This study was undertaken to establish a cutoff significant titer for Widal test using healthy volunteers as control group. Utilizing the baseline titer obtained from the control group, a diagnosis of typhoid fever was made in the test group comprising outpatients and inpatients. Methods: Blood samples were collected from healthy volunteers and patients attending G.S Medical College and Hospital, Pilkhuwa, over a period of 6 months from September 2016 to March 2017. Antibodies to Salmonella typhi (TO, TH) and Paratyphi A (AH) and Paratyphi B (BH) are determined by this tube agglutination test. A total of 124 healthy controls and 303 patients having clinical suspicion of typhoid fever were subjected to Widal test. Results: In healthy control group, titer TO ≥20 was observed in 43 (34.7%), TO ≥40 in 48 (38.7%), TO≥80 in 25 (20.2%), and titer TO ≥160, TO ≥320 was observed in none of the control group. Titer TH ≥40 in 58 (46.8%), AH ≥40 in 7 (5.6%), and BH ≥40 in 13 (10.5%) were observed in the control group. Among the test group, 96 (31.7%) sera were positive out of 303 clinically suspected enteric fever by the Widal test. Among different age group studied, 34 (46.6%) patients belonged to the age group of 11-20 years which formed the highest followed by the age group of 21-30 years (33.3%). Conclusion: Based on the study, a cutoff titer of ≥160 for anti-O and anti-H antibodies and titer of ≥80 for anti-AH and anti-BH antibodies be considered as significant titer in diagnosis of enteric fever in this region. The baseline titer helps in early recognition and treatment of this serious health problem.


2011 ◽  
Vol 5 (1) ◽  
pp. 16-20 ◽  
Author(s):  
Bulbul Hasan ◽  
Sabera Gul Nahar ◽  
Laila Akter ◽  
Ahmed Abu Saleh

The present study has been carried out in an attempt to evaluate antimicrobial susceptibility patterns with special reference to susceptibility of Salmonella Typhi to ciprofloxacin isolated from blood culture. The study is also designed to find out the MIC of Ciprofloxacin by E- test. Blood samples were taken for culture sensitivity, Widal test and ICT from 100 clinically suspected cases of typhoid fever in 1st week of illness who attended at out patient department of Rajshahi Medical College Hospital (RMCH).The study was done in Microbiology Department of Rajshahi Medical College and Shishu Hospital, Dhaka. Diagnosis of patients was based on history of fever, blood culture, Widal test and ICT. The antimicrobial susceptibility pattern of isolates from blood culture was recorded. Further more, the minimum inhibitory concentration of Ciprofloxacin was determined by E-test for the isolates resistance to Ciprofloxacin. Out of 100 suspected cases of typhoid fever, blood culture positive for S. Typhi were 16 (16%). Antimicrobial susceptibility pattern of 16 isolates of S. Typhi showed that no isolate was resistant to Ceftriaxone and Ceftazidime, only 03(18.75%) were resistant to Ciprofloxacin and Azithromycin whereas 10(62.5%) were MDR showing resistance to Ampicillin, Co-trimoxazole and Chloramphenicol which are first-line antityphoidal drugs. On the other hand, all (100%) the isolates were resistant to Nalidixic acid. The study revealed that Ceftriaxone and Ceftazidime are the most effective drugs in the treatment of typhoid fever. Moreover, E-test has been found to be helpful to determine appropriate therapeutic dose of Ciprofloxacin especially in case of drug resistance and pediatric population.DOI: http://dx.doi.org/10.3329/bjmm.v5i1.15816 Bangladesh J Med Microbiol 2011; 05 (01): 16-20


2018 ◽  
Vol 48 (3) ◽  
pp. 182-188 ◽  
Author(s):  
Rini Bandyopadhyay ◽  
Veeraghavan Balaji ◽  
Bijesh Yadav ◽  
Sudha Jasmine ◽  
Sowmya Sathyendra ◽  
...  

The epidemiology of typhoid fever in South Asia has changed. Multi-drug resistant (MDR) Salmonella typhi ( S. typhi) is now frequently resistant to nalidixic acid and thus labelled NARST. Treatment failure with the use of fluoroquinolones has been widely noted, forcing clinicians to adopt alternative treatment strategies. In this observational study, we looked at various treatment regimens and correlated clinical and microbiological outcomes. In 146 hospitalised adults, the median minimum inhibitory concentration (MIC) for ciprofloxacin was 0.38 µg/mL with a median fever clearance time (FCT) of eight days (range = 2–35 days). Of the regimens used, gatifloxacin and azithromycin had a shorter FCT of six days compared to ceftriaxone (ten days; P < 0.001). Though mortality and relapse in our cohort was low, NARST seemed to correlate with mortality ( P = 0.006). Gatifloxacin or azithromycin clearly emerge as the drugs of choice for treatment of typhoid in South India.


2020 ◽  
Vol 14 (1) ◽  
pp. 18-25
Author(s):  
Farjana Akter ◽  
Mahmuda Yeasmin ◽  
Md Zahangir Alam ◽  
Md Rokibul Hasan ◽  
Fahmida Rahman ◽  
...  

Background: Accurate and early diagnosis of enteric fever is a diagnostic challenge where facility for blood culture is not available. As a result, Widal test is still used widely in resource limited settings. Recently, user-friendly rapid immunochromatographic tests (ICT) have been introduced for quick diagnosis of enteric fever. So, we evaluated sensitivity and specificity of an immunochromatography based Salmonella Typhi IgM/IgG test kit and Widal test compared to blood culture for the diagnosis of enteric fever. Method: The study was conducted in the Department of Microbiology, Ibrahim Medical College (IMC) and Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) from June 2017 to September 2017. Clinically suspected enteric fever cases were included. Blood culture, Widal and Salmonella Typhi IgM/IgG detecting ICT were employed for the diagnosis of enteric fever. Results: Out of 71 suspected cases of enteric fever, blood culture was positive in 36 cases (50.7%) while 42 (59.15%) and 35 (49.29%) cases were positive by Widal test and ICT respectively. Widal and ICT had sensitivity and specificity of 100% and 89.9% and 82.9% & 91.4% respectively. Conclusion: Findings of the study suggest that both Widal and immunochromatographic tests can be used interchangeably for rapid diagnosis of enteric fever. Ibrahim Med. Coll. J. 2020; 14(1): 18-25


Author(s):  
S. Aarifaa ◽  
Kaliannan Mayilananthi ◽  
Durga Krishnan ◽  
V. R. Mohan Rao ◽  
Praveen Srinivas

Typhoid fever is an endemic infection in developing countries like India. Oral manifestations of enteric fever and typhoid tonsillitis have rarely been reported in the literature.   We report a 20 year old male, showing tonsillitis to be an integral part of clinical presentation of typhoid fever.The patient presented with fever, throat pain and oral ulcers. Blood culture and swab from tonsils showed significant growth of Salmonella typhi.This case report adds light to tonsillitis as a rare clinical manifestation of typhoid fever.


2018 ◽  
Vol 16 (2) ◽  
pp. 228-232
Author(s):  
Rajesh Dhoj Joshi ◽  
Sachin Khadka ◽  
Deepak Man Joshi ◽  
Basudha Shrestha ◽  
Ganesh Dangal ◽  
...  

Background: For diagnosis of enteric fever, the culture of the organism from different body fluids is the gold standard. After diagnosis, it is important to treat with the right antibiotic before any complications can occur. The retrospective study is designed to explore the antibiotic sensitivity trend in blood culture positive typhoid fever cases and the extent of drug resistance before treatment is administered.Methods: A retrospective study was carried out for culture isolated enteric fever patients admitted in Kathmandu Model Hospital. The discharged records from January 2012 to December 2016 were analyzed. The patients above 15 years and with culture isolated enteric fever were included in the study.Results: One hundred fifty-nine strains of Salmonella typhi and paratyphi were isolated from Jan 2012 to Dec 2016 at Kathmandu Model Hospital. Out of 159 isolated, 125 (78.6%) were Salmonella typhi and 34 (21.4%) were paratyphi. Among them co-trimoxazole, chloramphenicol, ceftriaxone, cefotaxime, cefixime, and ofloxacin demonstrated 100% sensitivity. Similarly, amoxicillin sensitivity was 98.1% (n=156) while ciprofloxacin was sensitive in 6.3% (n=10), intermediately sensitive in 49.1% (n=78) and resistance in 44.7% (n=71).The newer quinolone levofloxacin showed 78.5% (n=11) sensitivity. Azithromycin was sensitive in 99.2% (n=132) of total isolated Salmonella species both typhi and paratyphi. Conclusions: A high degree of sensitivity was noted to chloramphenicol and co-trimoxazole, showing sensitivity has returned to conventional antibiotics. The drug-like ofloxacin is still the best responding drug in our contest whereas ciprofloxacin resistance is still high, but five years patterns show a trend of rollback of sensitivity. Keywords: Cephalosporin; enteric fever; sensitivity.


2019 ◽  
Vol 11 (03) ◽  
pp. 234-239 ◽  
Author(s):  
Debabrata Dash ◽  
Padma Das ◽  
Anudita Bhargava ◽  
Ujjwala Nitin Gaikwad ◽  
Sanjay Singh Negi ◽  
...  

Abstract BACKGROUND: Enteric fever is the most common cause of community acquired blood stream infections in under developed and developing countries. The enteric fever is exclusive to humans and transmitted through the faeco-oral route. Though India is an endemic zone for enteric fever, the data is very scarce from Central India. The present study was undertaken to determine the prevalence of enteric fever in this region and to know the antimicrobial susceptibility pattern of the isolated typhoidal Salmonellae. MATERIAL AND METHOD: We conducted a retrospective analysis of blood culture positive cases of enteric fever over a period of two years (December 2015 to December 2017). All blood cultures submitted for suspected enteric fever and associated symptoms were included in the study. Relevant demographic, clinical and laboratory data were analyzed. RESULT: A total of 51 cases (3.56%) were of typhoidal Salmonella from a total of 1430 blood culture submission. Salmonella Typhi were 70.5% while Salmonella Paratyphi A were 29.5% of the total isolated Salmonellae. The most vulnerable age group was 10-19years (41.2%). The mean minimum inhibitory concentration of ciprofloxacin for Salmonella Typhi and Salmonella Paratyphi A are 1.20 and 1.97 μg/ml respectively. All the isolates were susceptible to ceftriaxone. Highest isolation was in the July – September quarter (35.3%). CONCLUSION: There is a high prevalence of the disease which needs urgent focus on safe water, sanitation services and also to establish guidelines for empiric therapy for enteric fever.


2018 ◽  
Vol 16 (2) ◽  
pp. 228-232 ◽  
Author(s):  
Rajesh Dhoj Joshi ◽  
Sachin Khadka ◽  
Deepak Man Joshi ◽  
Basudha Shrestha ◽  
Ganesh Dangal ◽  
...  

Background: For diagnosis of enteric fever, the culture of the organism from different body fluids is the gold standard. After diagnosis, it is important to treat with the right antibiotic before any complications can occur. The retrospective study is designed to explore the antibiotic sensitivity trend in blood culture positive typhoid fever cases and the extent of drug resistance before treatment is administered.Methods: A retrospective study was carried out for culture isolated enteric fever patients admitted in Kathmandu Model Hospital. The discharged records from January 2012 to December 2016 were analyzed. The patients above 15 years and with culture isolated enteric fever were included in the study.Results: One hundred fifty-nine strains of Salmonella typhi and paratyphi were isolated from Jan 2012 to Dec 2016 at Kathmandu Model Hospital. Out of 159 isolated, 125 (78.6%) were Salmonella typhi and 34 (21.4%) were paratyphi. Among them co-trimoxazole, chloramphenicol, ceftriaxone, cefotaxime, cefixime, and ofloxacin demonstrated 100% sensitivity. Similarly, amoxicillin sensitivity was 98.1% (n=156) while ciprofloxacin was sensitive in 6.3% (n=10), intermediately sensitive in 49.1% (n=78) and resistance in 44.7% (n=71).The newer quinolone levofloxacin showed 78.5% (n=11) sensitivity. Azithromycin was sensitive in 99.2% (n=132) of total isolated Salmonella species both typhi and paratyphi.Conclusions: A high degree of sensitivity was noted to chloramphenicol and co-trimoxazole, showing sensitivity has returned to conventional antibiotics. The drug-like ofloxacin is still the best responding drug in our contest whereas ciprofloxacin resistance is still high, but five years patterns show a trend of rollback of sensitivity.


Sign in / Sign up

Export Citation Format

Share Document