Document Detail

Treatment of typhoid fever in the 21st century: promises and shortcomings.
MedLine Citation:
PMID:  21722249     Owner:  NLM     Status:  MEDLINE    
Emergence of multidrug resistance and decreased ciprofloxacin susceptibility (DCS) in Salmonella enterica serovar Typhi in South Asia have rendered older drugs, including ampicillin, chloramphenicol, trimethoprim-sulphamethoxazole, ciprofloxacin, and ofloxacin, ineffective or suboptimal for typhoid fever. Ideally, treatment should be safe and available for adults and children in shortened courses of 5 days, cause defervescence within 1 week, render blood and stool cultures sterile, and prevent relapse. In this review of 20 prospective clinical trials that enrolled more than 1600 culture-proven patients, azithromycin meets these criteria better than other drugs. Among fluoroquinolones, which are more effective than cephalosporins, gatifloxacin appears to be more effective than ciprofloxacin and ofloxacin for patients infected with bacteria showing DCS. Ceftriaxone continues to be useful as a back-up choice, and chloramphenicol, despite its toxicity for bone marrow and history of plasmid-mediated resistance, is making a comeback in developing countries that show their bacteria to be susceptible to it.
T Butler
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases     Volume:  17     ISSN:  1469-0691     ISO Abbreviation:  Clin. Microbiol. Infect.     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-07-04     Completed Date:  2011-10-18     Revised Date:  2013-04-24    
Medline Journal Info:
Nlm Unique ID:  9516420     Medline TA:  Clin Microbiol Infect     Country:  France    
Other Details:
Languages:  eng     Pagination:  959-63     Citation Subset:  IM    
Copyright Information:
© 2011 The Author. Clinical Microbiology and Infection © 2011 European Society of Clinical Microbiology and Infectious Diseases.
Department of Microbiology and Immunology, Ross University School of Medicine, North Brunswick, NJ 08902, USA.
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MeSH Terms
Anti-Bacterial Agents / therapeutic use*
Azithromycin / therapeutic use
Ceftriaxone / therapeutic use
Clinical Trials as Topic
Drug Resistance, Bacterial
Fluoroquinolones / therapeutic use
Salmonella typhi / drug effects*
Treatment Outcome
Typhoid Fever / drug therapy*
Reg. No./Substance:
0/Anti-Bacterial Agents; 0/Fluoroquinolones; 73384-59-5/Ceftriaxone; 83905-01-5/Azithromycin; L4618BD7KJ/gatifloxacin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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