Related Experiment Videos
Randomized clinical trial of furazolidone for typhoid fever in children
1Division of Clinical Medicine, National Institute of Cholera and Enteric Diseases, Calcutta, India.
Insights
Furazolidone is an effective alternative to chloramphenicol for treating typhoid fever, especially when Salmonella typhi strains are resistant to chloramphenicol. This study shows comparable cure rates for susceptible strains and higher efficacy against resistant strains.
Area of Science:
- Infectious Diseases
- Microbiology
- Pharmacology
Background:
- Typhoid fever remains a significant global health concern.
- Increasing antimicrobial resistance necessitates evaluating alternative treatments.
- Chloramphenicol resistance in Salmonella typhi poses a therapeutic challenge.
Purpose of the Study:
- To compare the efficacy of furazolidone and chloramphenicol in treating pediatric typhoid fever.
- To assess treatment outcomes based on Salmonella typhi susceptibility patterns.
- To determine if furazolidone is a viable alternative for chloramphenicol-resistant typhoid fever.
Main Methods:
- A randomized controlled trial involving 133 children with bacteriologically confirmed typhoid fever.
- Patients were randomized to receive either oral furazolidone (7.5 mg/kg/day) or chloramphenicol (75 mg/kg/day).
- Salmonella typhi isolates were tested for susceptibility to both antibiotics; clinical and bacteriologic outcomes were assessed.
Main Results:
- Furazolidone demonstrated an 86.2% cure rate, significantly higher than chloramphenicol's 51.5% cure rate (P = 0.00003).
- For strains susceptible to both drugs, cure rates were similar (86.2% for furazolidone vs. 90.0% for chloramphenicol).
- Furazolidone showed a statistically significant advantage in treating infections caused by chloramphenicol-resistant strains (P = 0.000003).
Conclusions:
- Furazolidone is a satisfactory alternative for treating typhoid fever, particularly when caused by chloramphenicol-resistant Salmonella typhi.
- The study highlights the importance of antibiotic susceptibility testing in guiding typhoid fever treatment.
- No relapses or carriers were observed in either treatment group, suggesting high efficacy and safety profiles.
Abstract:
The efficacy of furazolidone and chloramphenicol was compared in a randomized trial involving 133 children with bacteriologically confirmed typhoid fever. Sixty-five children were randomized to receive furazolidone, 7.5 mg/kg/day, and 68 children to receive chloramphenicol, 75 mg/kg/day. Both drugs were administered orally. The clinical characteristics of the two treatment groups were comparable on admission. All the strains of Salmonella typhi isolated from the furazolidone group were susceptible to furazolidone. However, of the 68 strains of S. typhi isolated from the chloramphenicol group, 10 were susceptible and 58 were resistant to chloramphenicol. Clinical and bacteriologic cure was observed in 56 (86.2%) children treated with furazolidone and in 35 (51.5%) children given chloramphenicol who were infected with S. typhi strains, irrespective of susceptibility pattern (P = 0.00003). Cure was achieved in 86.2% of furazolidone recipients and 90.0% of chloramphenicol recipients who were infected with strains of S. typhi susceptible to both drugs (P = 0.6). The difference in cure rate was statistically significant (P = 0.000003) when the two treatment groups infected with furazolidone-susceptible but chloramphenicol-resistant strains of S. typhi were compared. There was no relapse or carriers in either of the groups. Furazolidone appears to be a satisfactory alternative to chloramphenicol in the treatment of typhoid fever caused by chloramphenicol-resistant strains of S. typhi.