Related Experiment Videos
An analysis of children with typhoid fever admitted in 1991
C T Deshmukh1, U B Nadkarni, S C Karande
1Dept. of Pediatrics, KEM Hospital, Parel, Bombay, Maharashtra.
Insights
Ciprofloxacin demonstrated a 0% treatment failure rate in children with typhoid fever, unlike other tested antibiotics. Multidrug-resistant Salmonella typhi was identified, but no specific clinical signs predicted it.
Area of Science:
- Pediatric Infectious Diseases
- Bacteriology and Serology
- Antimicrobial Resistance
Background:
- Typhoid fever remains a significant pediatric health concern, necessitating effective treatment strategies.
- Previous treatment guidelines recommended chloramphenicol, amoxycillin, or co-trimoxazole for typhoid fever.
- Emergence of multidrug-resistant Salmonella typhi strains poses a challenge to conventional therapies.
Purpose of the Study:
- To evaluate the efficacy of different antibiotic regimens in treating typhoid fever in children.
- To assess the treatment failure rates of chloramphenicol, amoxycillin, and co-trimoxazole.
- To determine the effectiveness of ciprofloxacin as a salvage therapy for resistant typhoid fever cases.
Main Methods:
- A study involving 28 children diagnosed with typhoid fever.
- Initial treatment with one of three recommended drugs (chloramphenicol, amoxycillin, co-trimoxazole) for 7 days.
- Sequential therapy with alternative drugs upon treatment failure, with ciprofloxacin used after two prior drug failures.
Main Results:
- 18 (64.3%) children responded to initial therapy with chloramphenicol, amoxycillin, or co-trimoxazole.
- Ciprofloxacin was administered to 19 (35.7%) cases, exhibiting a 0% treatment failure rate.
- Treatment failure rates were 50% for chloramphenicol, 71.4% for amoxycillin, and 75% for co-trimoxazole.
- Splenomegaly and absolute eosinopenia were key clinical indicators for diagnosis.
- Blood cultures identified Salmonella typhi in 7 cases, with 5 (72%) being multidrug-resistant.
- No distinct clinical features differentiated multidrug-resistant typhoid fever.
Conclusions:
- Ciprofloxacin proved highly effective in managing treatment failures in pediatric typhoid fever.
- High failure rates associated with chloramphenicol, amoxycillin, and co-trimoxazole highlight the need for alternative agents.
- The study underscores the challenge of identifying multidrug-resistant typhoid fever based on clinical presentation alone.
Abstract:
In 28 children, with bacteriologically and/or serologically diagnosed typhoid fever treated at KEM Hospital, Bombay in 1991, initially one of the three recommended drugs (viz. chloramphenicol, amoxycillin or co-trimoxazole) was given for 7 days for defervescence to occur. In those who failed to respond, a second trial of therapy with one of the other two drugs was initiated, after omitting the first drug. A second failure of therapy was taken as an indication to use ciprofloxacin singly. Eventually, 18 (64.3%) cases responded to chloramphenicol or amoxycillin or co-trimoxazole. Ciprofloxacin was used in 19(35.7%) cases. the failure rate of treatment with chloramphenicol was 50%, with amoxycillin 71.4%, with co-trimoxazole 75% and 0% with ciprofloxacin. An analysis of the 28 cases revealed that apart from fever (in 100%), splenomegaly (in 82.1%) was the most important clinical pointer to diagnosis, along with absolute eosinopenia (in 71.4%). There were no major complications, except 2 cases with typhoid hepatitis who responded to choramphenicol and co-trimoxazole, respectively. Blood culture grew Salmonella typhi in 7 cases, of which 5 (72%) were multidrug resistant S. typhi. There were no characteristic clinical features to identify multi-drug resistant typhoid fever.