Short course quinolone therapy of typhoid fever in developing countries

A 14-day course of chloramphenicol or cotrimoxazole has been standard chemotherapy for uncomplicated salmonella enteric fever for several decades. The new fluoroquinolones show in vitro minimum inhibitory concentrations against Salmonella spp. ranging from 0.003 to 0.25 mg/L. Early clinical trials with 14-day courses of ciprofloxacin, ofloxacin or pefloxacin given orally achieved cure rates of 100%. Subsequent trials with 7- to 10-day courses of these fluoroquinolones also consistently yielded cure rates of 100%, whereas more recent trials of 3- to 6-day courses reported preliminary cure rates of 67 to 99%. At present, it appears that fluoroquinolone therapy for at least 7 days is a cost-effective substitute for the standard drugs in uncomplicated salmonella infections resistant to cotrimoxazole and/or chloramphenicol. The use of shorter 3- to 6-day courses of fluoroquinolone therapy needs further study, in view of lower cure rates reported in preliminary clinical trials.