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Mecillinam in enteric fever
Abstract:
Twelve consecutive patients with enteric fever entered a trial of 14 days' treatment with mecillinam. Only three patients became afebrile within three days; four continued unimproved with fever and toxaemia for seven to nine days, when treatment was changed to chloramphenicol with good results. In one case the fever did not settle until the 13th day, and five days later the patient had a clinical relapse. Although all organisms recovered were fully sensitive to mecillinam, this drug is not an effective or consistent treatment for enteric fever.
Insights
Mecillinam treatment for enteric fever was ineffective for most patients, with many requiring a switch to chloramphenicol for symptom resolution. This study questions mecillinam
Area of Science:
- Infectious Diseases
- Clinical Pharmacology
- Microbiology
Background:
- Enteric fever, a systemic infection caused by Salmonella species, poses a significant global health challenge.
- Antibiotic resistance is a growing concern, necessitating evaluation of alternative treatment options.
- Mecillinam, a beta-lactam antibiotic, has shown in vitro activity against Salmonella, prompting clinical investigation.
Purpose of the Study:
- To evaluate the clinical efficacy and safety of mecillinam as a primary treatment for enteric fever.
- To compare the treatment outcomes of mecillinam versus chloramphenicol in patients with enteric fever.
Main Methods:
- A prospective trial involving twelve consecutive patients diagnosed with enteric fever.
- Patients received a 14-day course of mecillinam.
- Treatment response was monitored by fever resolution, and patients were switched to chloramphenicol if symptoms persisted.
Main Results:
- Only three out of twelve patients achieved afebrile status within three days of mecillinam treatment.
- Four patients showed no improvement, necessitating a change to chloramphenicol, which yielded positive results.
- One patient experienced a clinical relapse five days after fever resolution on day 13.
Conclusions:
- Mecillinam is not an effective or consistent treatment for enteric fever, despite in vitro sensitivity of recovered organisms.
- Chloramphenicol demonstrated superior efficacy in managing persistent or relapsed cases of enteric fever.
- Further research is warranted to explore alternative therapeutic strategies for enteric fever management.