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Therapeutic aspects of typhoidal salmonellosis in childhood: the Karachi experience

Z A Bhutta1

  • 1Department of Paediatrics, Aga Khan University Medical Center, Karachi, Pakistan.

Annals of Tropical Paediatrics
|December 1, 1996
PubMed

Insights

In children with typhoid, ampicillin and chloramphenicol were equally effective for drug-sensitive strains. Intravenous ceftriaxone showed better outcomes than cefotaxime for multi-drug-resistant typhoid infections.

Area of Science:

  • Infectious Diseases
  • Pediatric Medicine
  • Microbiology

Background:

  • Typhoid fever remains a significant public health concern, particularly in resource-limited settings.
  • The emergence of multi-drug-resistant (MDR) strains of Salmonella Typhi complicates treatment strategies.
  • Effective therapeutic options are crucial for reducing morbidity and mortality in pediatric typhoid cases.

Purpose of the Study:

  • To evaluate the efficacy of different antimicrobial agents in treating culture-proven typhoid in children.
  • To compare treatment outcomes for drug-sensitive and multi-drug-resistant typhoid strains.
  • To assess the effectiveness of third-generation cephalosporins in managing MDR typhoid.

Main Methods:

  • Retrospective analysis of 876 children with culture-proven typhoid admitted to The Aga Khan University Hospital.
  • Comparison of treatment outcomes (cure rates, failure rates, time to defervescence) for ampicillin, chloramphenicol, cefotaxime, and ceftriaxone.
  • Stratification of analysis based on antimicrobial susceptibility patterns of Salmonella Typhi isolates.

Main Results:

  • Ampicillin and chloramphenicol showed comparable efficacy in children with drug-sensitive typhoid.
  • Intravenous ceftriaxone demonstrated superior outcomes compared to cefotaxime in treating MDR typhoid.
  • Children with MDR typhoid treated with ceftriaxone experienced a longer time to defervescence than those with sensitive strains.

Conclusions:

  • Early recognition and appropriate second-line therapy, such as ceftriaxone, have significantly reduced typhoid case fatality rates.
  • A 14-day course of ceftriaxone is effective for most hospitalized children with MDR typhoid.
  • Further research is needed to explore short-course therapies and alternative agents for MDR typhoid.

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