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Short course chemotherapy with cefixime in children with multidrug-resistant Salmonella typhi Septicaemia
N I Girgis1, D R Tribble, Y Sultan
1US Naval Medical Research Unit No. 3, Cairo, Egypt.
Insights
A short, 8-day course of oral cefixime effectively treated multidrug-resistant typhoid fever in children. This antibiotic regimen demonstrated safety and high clinical cure rates in pediatric patients, offering a viable treatment option.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Resistance
- Clinical Pharmacology
Background:
- Multidrug-resistant (MDR) Salmonella typhi strains are increasingly prevalent in pediatric typhoid fever cases.
- Fluoroquinolone restrictions in children necessitate evaluating alternative antibiotic regimens.
- Previous studies demonstrated the safety and efficacy of a 12-day oral cefixime regimen.
Purpose of the Study:
- To investigate the safety and efficacy of a short (8-day) oral cefixime regimen for pediatric MDR typhoid fever.
- To assess clinical cure rates and tolerability of the shortened cefixime course.
Main Methods:
- An open trial was conducted in an Egyptian public fever hospital.
- Eighty children were enrolled; 60 had blood culture-confirmed typhoid fever.
- Clinical outcomes and side effects were monitored for the 8-day cefixime treatment.
Main Results:
- Clinical cure was achieved in 95% (57/60) of children with confirmed typhoid fever.
- All Salmonella typhi isolates were sensitive to cefixime via disk diffusion.
- Mild side effects (nausea, vomiting, abdominal cramping) were reported in a small percentage of patients.
Conclusions:
- An 8-day course of oral cefixime is safe and effective for managing pediatric MDR typhoid fever.
- The shortened regimen offers a promising therapeutic option given current treatment challenges.
- Cefixime demonstrated good tolerability in the pediatric population studied.
Abstract:
Increasing prevalence of multidrug-resistant (MDR) Salmonella typhi strains in pediatric cases of typhoid fever and chemotherapy restrictions in children, such as fluoroquinolones, require ongoing clinical evaluations of different antibiotic regimens. Previously reported clinical trials with oral cefixime therapy given as a 12-day regimen (20-30 mg/kg divided twice daily) demonstrated both safety and efficacy. An open trial was undertaken to investigate a short course (8-day) regimen of oral cefixime in an Egyptian public fever hospital. Eighty children were initially enrolled with blood culture confirmation in 60 children. Clinical cure was documented in 57 (95 per cent) with three children requiring a change in antibiotic regimen due to therapeutic failure and one child with culture-confirmed relapsed 21 days post-therapy. All S. typhi isolates were sensitive to cefixime as measured by disk diffusion. Cefixime was well-tolerated with only mild side-effects, including nausea/vomiting (8 per cent) and abdominal cramping with loose stools (6 per cent), which may have been secondary to typhoid fever. Cefixime given in a short 8-day course is safe and effective in the management of MDR typhoid fever in children.