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Short course of ofloxacin for treatment of multidrug-resistant typhoid
T H Tran1, D B Bethell, T T Nguyen
1Centre for Tropical Diseases, Cho Quan Hospital, Ho Chi Minh City, Vietnam.
Abstract:
In recent years, multiresistant strains of Salmonella typhi have emerged in many tropical countries. These strains remain highly sensitive to the fluoroquinolone antibiotics, although use of these drugs by children is considered contraindicated because of their reported toxicity in the cartilage of experimental animals. In a paired, open, randomized study during an epidemic of multidrug-resistant typhoid in southern Vietnam, two short-course ofloxacin regimens (15 mg/kg daily for 3 days and 10 mg/kg daily for 5 days) were compared for the treatment of uncomplicated typhoid fever. Of 438 patients enrolled (of whom 286 were < or = 14 years old), 228 had blood cultures positive for Salmonella species (S. typhi, 207; S. paratyphi A, 19; and S. choleraesuis, 2). There was one treatment failure in a patient who took only one dose of ofloxacin. Otherwise, both regimens were completely effective; there were no proven carriers, and there was no evidence of toxicity, particularly in children. A 3-day course of ofloxacin proved to be safe and highly effective in the treatment of uncomplicated, multidrug-resistant typhoid fever.
Insights
A 3-day course of ofloxacin is safe and effective for treating multidrug-resistant typhoid fever in children and adults. This antibiotic offers a crucial treatment option where other drugs have failed.
Area of Science:
- Infectious Diseases
- Microbiology
- Pharmacology
Background:
- Multidrug-resistant Salmonella typhi strains are a growing concern in tropical regions.
- Fluoroquinolones are effective against these resistant strains but raise safety concerns in pediatric populations due to potential cartilage toxicity.
- Previous studies have indicated contraindications for fluoroquinolone use in children.
Purpose of the Study:
- To compare the efficacy and safety of two short-course ofloxacin regimens for treating uncomplicated multidrug-resistant typhoid fever.
- To evaluate the safety of ofloxacin in pediatric patients during a typhoid epidemic.
- To determine the optimal duration for ofloxacin treatment in typhoid fever.
Main Methods:
- A paired, open, randomized study was conducted during a multidrug-resistant typhoid epidemic in southern Vietnam.
- Two ofloxacin regimens were compared: 15 mg/kg daily for 3 days and 10 mg/kg daily for 5 days.
- 438 patients were enrolled, including 286 children aged 14 years or younger, with blood cultures analyzed for Salmonella species.
Main Results:
- Both ofloxacin regimens demonstrated complete effectiveness, with only one treatment failure in a patient with incomplete dosage.
- No cases of proven typhoid carriers were identified following treatment.
- No evidence of toxicity, particularly in the pediatric group, was observed with either regimen.
Conclusions:
- A 3-day course of ofloxacin is a safe and highly effective treatment for uncomplicated, multidrug-resistant typhoid fever.
- Ofloxacin presents a viable therapeutic option for typhoid fever, even in pediatric populations, challenging previous safety concerns.
- Short-course ofloxacin therapy can be recommended for typhoid fever management in resource-limited settings with high rates of drug resistance.