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Comparative efficacies of aztreonam and chloramphenicol in children with typhoid fever
J Tanaka-Kido1, L Ortega, J I Santos
1Departamento de Enfermedades Infecciosas y Parasitarias, Hospital Infantil de México, Federico Gómez, Mexico City.
Insights
Aztreonam offers a safe and effective alternative for treating pediatric typhoid fever, especially when Salmonella typhi strains are resistant to other antibiotics like chloramphenicol.
Area of Science:
- Infectious Diseases
- Pediatric Medicine
- Pharmacology
Background:
- Typhoid fever remains a significant public health concern in children.
- Chloramphenicol has been a traditional treatment, but rising antimicrobial resistance necessitates alternative therapies.
- Aztreonam presents a potential option for managing typhoid fever, particularly in drug-resistant cases.
Purpose of the Study:
- To compare the efficacy and safety of aztreonam versus chloramphenicol in treating pediatric typhoid fever.
- To evaluate treatment outcomes, including duration of fever, clinical cure rates, and adverse reactions.
- To assess the susceptibility of Salmonella typhi strains to aztreonam and other antibiotics.
Main Methods:
- A randomized controlled trial involving 36 children diagnosed with typhoid fever.
- Patients were assigned to receive either intravenous aztreonam (150 mg/kg/day) or oral chloramphenicol (100 mg/kg/day).
- Clinical characteristics, treatment duration, fever resolution, cure rates, relapses, and adverse events were monitored.
Main Results:
- No significant difference in the mean duration of fever between aztreonam (5.9 days) and chloramphenicol (4.05 days) groups (P > 0.05).
- Clinical cure was achieved in all aztreonam-treated patients and 17 of 18 chloramphenicol-treated patients; one mortality occurred in the chloramphenicol group.
- All Salmonella typhi isolates were susceptible to aztreonam, while some showed resistance to chloramphenicol and ampicillin. Two patients experienced adverse reactions to aztreonam.
Conclusions:
- Aztreonam is a satisfactory alternative to chloramphenicol for treating pediatric typhoid fever.
- It is particularly valuable for infections caused by chloramphenicol-resistant Salmonella typhi strains or when chloramphenicol is contraindicated.
- Aztreonam demonstrated a favorable safety profile in this pediatric cohort.
Abstract:
We compared aztreonam with chloramphenicol in a randomized trial involving the treatment of 36 children with typhoid fever. Eighteen children were randomized to receive aztreonam, 150 mg/kg/day intravenously, and 18 to receive chloramphenicol, 100 mg/kg/day orally. On entry in the study the clinical characteristics of the two treatment groups were comparable. The duration of therapy was 14.9 +/- 3.6 days for the aztreonam group and 12.8 +/- 2.6 days for the chloramphenicol group. The mean duration of fever was 5.9 +/- 3.1 days and 4.05 +/- 2.1 days for aztreonam and chloramphenicol groups respectively (P greater than 0.05). Clinical cure was observed in all patients treated with aztreonam and in 17 of 18 children given chloramphenicol; one patient died in the latter group. There were no relapses in either group. We observed clinical adverse reactions during the treatment with aztreonam in 2 patients. All strains of Salmonella typhi were susceptible to aztreonam, 1 strain was resistant to chloramphenicol and 3 strains were resistant to ampicillin. Aztreonam appears to be a satisfactory alternative to chloramphenicol in cases of typhoid fever caused by resistant strains or when chloramphenicol is contraindicated.