Effects of pefloxacin in multi drug resistant typhoid Fever

Area of Science:

• Pediatric Infectious Diseases
• Antimicrobial Resistance
• Clinical Microbiology

Background:

• Typhoid fever remains a significant public health concern, particularly in developing regions.
• Increasing antimicrobial resistance poses challenges to effective treatment regimens.
• Understanding clinical indicators is vital for timely diagnosis and management.

Purpose of the Study:

• To evaluate the efficacy of different drug therapies for typhoid fever in children.
• To assess the treatment failure rates of chloramphenicol, amoxycillin, and co-trimoxazole.
• To determine the effectiveness of pefloxacin as a second-line or salvage therapy.

Main Methods:

• A study involving 28 children diagnosed with typhoid fever.
• Sequential drug therapy: initial trial with one of three drugs (chloramphenicol, amoxycillin, co-trimoxazole) for 7 days.
• Second-line therapy with an alternative drug upon treatment failure; pefloxacin used after second failure.

Main Results:

• 18 (64.3%) cases responded to initial therapies (chloramphenicol, amoxycillin, or co-trimoxazole).
• Pefloxacin was used in 10 (35.7%) cases with a 0% failure rate.
• Treatment failure rates were 50% for chloramphenicol, 71.4% for amoxycillin, and 75% for co-trimoxazole.
• Fever (100%) and splenomegaly (82.1%) were key clinical indicators; absolute eosinopenia (71.4%) was also noted.
• Blood cultures identified Salmonella typhi in 7 cases, with 72% exhibiting multi-drug resistance.

Conclusions:

• Pefloxacin shows promise as an effective treatment for refractory typhoid fever in children.
• High failure rates observed with chloramphenicol, amoxycillin, and co-trimoxazole highlight emerging resistance.
• Clinical signs like fever and splenomegaly are important diagnostic markers in pediatric typhoid.