Cefixime: an oral option for the treatment of multidrug-resistant enteric fever in children.
BACKGROUND
Enteric fever is a serious public health problem in Pakistan, where multidrug-resistant salmonellosis causes enteric fever with increased morbidity and mortality. Costly parenteral therapy and lack of an established safety profile for the use of quinolones in children necessitate evaluation of an oral treatment option. This study is meant to assess the efficacy, safety, and cost effectiveness of an oral third-generation cephalosporin (cefixime) in the treatment of multidrug-resistant enteric fever.


METHODS
Between November 1993 and October 1994, 85 patients, 15 years of age or less, with culture-proven enteric fever were randomly assigned to two groups. Group A (n = 41) received cefixime at a dosage of 10 mg/kg to 12 mg/kg per day in two divided doses. Group B (n = 44) received chloramphenicol at a dosage of 100 mg/kg daily in four divided doses. Both groups were treated for 2 weeks.


RESULTS
In group A, 95% (39/41) of the patients receiving cefixime responded favorably, whereas in group B, 30% (14/45) responded to chloramphenicol. The 31 patients not cured in group B were then successfully treated with cefixime. Overall, cefixime was well tolerated. Subsequent antibiogram data showed an overall multidrug-resistance rate of 78% (66/85).


CONCLUSIONS
Cefixime is a safe, effective, and cheaper oral option for the treatment of multidrug-resistant enteric fever. Further studies are needed, however, to validate this observation.
Memon
I A
IA
Department of Pediatrics, Dow Medical College, Civil Hospital, Karachi, Pakistan.
Billoo
A G
AG
Memon
H I
HI
D000284:Administration, Oral; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D020682:Cefixime; D002439:Cefotaxime / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D002511:Cephalosporins / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002701:Chloramphenicol / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D018432:Drug Resistance, Multiple; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012485:Salmonella typhi / Q000187:drug effects; D016896:Treatment Outcome; D014435:Typhoid Fever / Q000188:drug therapy*
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D002701:Chloramphenicol; D020682:Cefixime; D002439:Cefotaxime