Open label comparative trial of mono versus dual antibiotic therapy for Typhoid Fever in adults.
Emerging resistance to antibiotics renders therapy of Typhoid Fever (TF) increasingly challenging. The current single-drug regimens exhibit prolonged fever clearance time (FCT), imposing a great burden on both patients and health systems, and potentially contributing to the development of antibiotic...
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ftdoajarticles:oai:doaj.org/article:dcb8a8bca87b4d57a5ca60e52d4795f9 2023-05-15T15:15:13+02:00 Open label comparative trial of mono versus dual antibiotic therapy for Typhoid Fever in adults. Niv Zmora Sudeep Shrestha Ami Neuberger Yael Paran Rajendra Tamrakar Ashish Shrestha Surendra K Madhup T R S Bedi Rajendra Koju Eli Schwartz 2018-04-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0006380 https://doaj.org/article/dcb8a8bca87b4d57a5ca60e52d4795f9 EN eng Public Library of Science (PLoS) http://europepmc.org/articles/PMC5912710?pdf=render https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0006380 https://doaj.org/article/dcb8a8bca87b4d57a5ca60e52d4795f9 PLoS Neglected Tropical Diseases, Vol 12, Iss 4, p e0006380 (2018) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2018 ftdoajarticles https://doi.org/10.1371/journal.pntd.0006380 2022-12-31T01:54:46Z Emerging resistance to antibiotics renders therapy of Typhoid Fever (TF) increasingly challenging. The current single-drug regimens exhibit prolonged fever clearance time (FCT), imposing a great burden on both patients and health systems, and potentially contributing to the development of antibiotic resistance and the chronic carriage of the pathogens. The aim of our study was to assess the efficacy of combining third-generation cephalosporin therapy with azithromycin on the outcomes of TF in patients living in an endemic region.An open-label, comparative trial was conducted at Dhulikhel Hospital, Nepal, between October 2012 and October 2014. Only culture-confirmed TF cases were eligible. Patients were alternately allocated to one of four study arms: hospitalized patients received either intravenous ceftriaxone or a combination of ceftriaxone and oral azithromycin, while outpatients received either oral azithromycin or a combination of oral azithromycin and cefexime. The primary outcome evaluated was FCT and the secondary outcomes included duration of bacteremia.105 blood culture-confirmed patients, of whom 51 were treated as outpatients, were eligible for the study. Of the 88 patients who met the inclusion criteria for FCT analysis 41 patients received a single-agent regimen, while 47 patients received a combined regimen. Results showed that FCT was significantly shorter for the latter (95 versus 88 hours, respectively, p = 0·004), and this effect was exhibited in both the hospitalized and the outpatient sub-groups. Repeat blood cultures, drawn on day 3, were positive for 8/47 (17%) patients after monotherapy, versus 2/51 (4%) after combination therapy (p = 0·045). No severe complications or fatalities occurred in any of the groups.Combined therapy of third-generation cephalosporins and azithromycin for TF may surpass monotherapy in terms of FCT and time to elimination of bacteremia.Trial registration number: NCT02224040. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic PLOS Neglected Tropical Diseases 12 4 e0006380 |
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English |
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Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
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Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Niv Zmora Sudeep Shrestha Ami Neuberger Yael Paran Rajendra Tamrakar Ashish Shrestha Surendra K Madhup T R S Bedi Rajendra Koju Eli Schwartz Open label comparative trial of mono versus dual antibiotic therapy for Typhoid Fever in adults. |
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Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
Emerging resistance to antibiotics renders therapy of Typhoid Fever (TF) increasingly challenging. The current single-drug regimens exhibit prolonged fever clearance time (FCT), imposing a great burden on both patients and health systems, and potentially contributing to the development of antibiotic resistance and the chronic carriage of the pathogens. The aim of our study was to assess the efficacy of combining third-generation cephalosporin therapy with azithromycin on the outcomes of TF in patients living in an endemic region.An open-label, comparative trial was conducted at Dhulikhel Hospital, Nepal, between October 2012 and October 2014. Only culture-confirmed TF cases were eligible. Patients were alternately allocated to one of four study arms: hospitalized patients received either intravenous ceftriaxone or a combination of ceftriaxone and oral azithromycin, while outpatients received either oral azithromycin or a combination of oral azithromycin and cefexime. The primary outcome evaluated was FCT and the secondary outcomes included duration of bacteremia.105 blood culture-confirmed patients, of whom 51 were treated as outpatients, were eligible for the study. Of the 88 patients who met the inclusion criteria for FCT analysis 41 patients received a single-agent regimen, while 47 patients received a combined regimen. Results showed that FCT was significantly shorter for the latter (95 versus 88 hours, respectively, p = 0·004), and this effect was exhibited in both the hospitalized and the outpatient sub-groups. Repeat blood cultures, drawn on day 3, were positive for 8/47 (17%) patients after monotherapy, versus 2/51 (4%) after combination therapy (p = 0·045). No severe complications or fatalities occurred in any of the groups.Combined therapy of third-generation cephalosporins and azithromycin for TF may surpass monotherapy in terms of FCT and time to elimination of bacteremia.Trial registration number: NCT02224040. |
format |
Article in Journal/Newspaper |
author |
Niv Zmora Sudeep Shrestha Ami Neuberger Yael Paran Rajendra Tamrakar Ashish Shrestha Surendra K Madhup T R S Bedi Rajendra Koju Eli Schwartz |
author_facet |
Niv Zmora Sudeep Shrestha Ami Neuberger Yael Paran Rajendra Tamrakar Ashish Shrestha Surendra K Madhup T R S Bedi Rajendra Koju Eli Schwartz |
author_sort |
Niv Zmora |
title |
Open label comparative trial of mono versus dual antibiotic therapy for Typhoid Fever in adults. |
title_short |
Open label comparative trial of mono versus dual antibiotic therapy for Typhoid Fever in adults. |
title_full |
Open label comparative trial of mono versus dual antibiotic therapy for Typhoid Fever in adults. |
title_fullStr |
Open label comparative trial of mono versus dual antibiotic therapy for Typhoid Fever in adults. |
title_full_unstemmed |
Open label comparative trial of mono versus dual antibiotic therapy for Typhoid Fever in adults. |
title_sort |
open label comparative trial of mono versus dual antibiotic therapy for typhoid fever in adults. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2018 |
url |
https://doi.org/10.1371/journal.pntd.0006380 https://doaj.org/article/dcb8a8bca87b4d57a5ca60e52d4795f9 |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
PLoS Neglected Tropical Diseases, Vol 12, Iss 4, p e0006380 (2018) |
op_relation |
http://europepmc.org/articles/PMC5912710?pdf=render https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0006380 https://doaj.org/article/dcb8a8bca87b4d57a5ca60e52d4795f9 |
op_doi |
https://doi.org/10.1371/journal.pntd.0006380 |
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PLOS Neglected Tropical Diseases |
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12 |
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4 |
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e0006380 |
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