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Uncomplicated Typhoid Fever; Comparison of Azithromycin and Ciprofloxacin in the Treatment

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Uncomplicated Typhoid Fever; Comparison of Azithromycin and Ciprofloxacin in the Treatment UNCOMPLICATED TYPHOID FEVER The Professional Medical Journal www.theprofesional.com ORIGINAL PROF-4014 DOI: 10.29309/TPMJ/18.4014 UNCOMPLICATED TYPHOID FEVER; COMPARISON OF AZITHROMYCIN AND CIPROFLOXACIN IN THE TREATMENT Kashif Ali1, Sajid Hussain2, Muhammad Saleem Akhter3, 1. FCPS Assistant Professor Medicine, ABSTRACRT… Objectives: Objectives of this study were To compare the clinical and Ghazi Khan Medical College, bacteriological cure rates of azithromycin and ciprofloxacin in the treatment of uncomplicated Dera Ghazi Khan. typhoid fever and To determine any difference in the clinical and bacteriological cure rates 2. FCPS DHQ / Teaching Hospital, within the two groups of study. Study Design: Quasi experimental study. Setting: Department Dera Ghazi Khan. of Medicine, DHQ/ Teaching Hospital Dera Ghazi Khan. Period: April 2016 to September 2016. 3. FCPS Patients and Methods: A total of 60 patients including both males and females over 18 years Associate Professor Medicine of age were included in the study by Simple random probability sampling. Patients fulfilling the Ghazi Khan Medical College, Dera Ghazi Khan. inclusion criteria were divided in two equal groups of 30 by using the random numbers table. First group was treated with azithromycin one gram on day one and then 500 mg daily for next Correspondence Address: six days. Second group was treated with ciprofloxacin 500mg twice daily for ten days. All the Dr. Kashif Ali Assistant Professor Medicine, data was analyzed by the computer programme SPSS. Frequency, percentages, mean values Ghazi Khan Medical College, and standard deviations were calculated for age, sex, symptoms, signs, culture reports, clinical Dera Ghazi Khan. cure rates and bacteriological cure rates. Results: Most common clinical feature was fever 03346772456 noted in 100% patients followed by headache (86.6%) and nausea / vomiting (76.6%). Out of [email protected] 60, 52 (86.6%) patients were culture positive. In Azithromycin group clinical and bacteriological Article received on: responses were achieved in 93.3% and 92.3% respectively while in ciprofloxacin group they 03/05/2017 were 96.6% and 96.15% respectively. There was no significant statistical difference between the Accepted for publication: 15/11/2017 clinical and bacteriological cure rates among two groups. Conclusion: Both ciprofloxacin and Received after proof reading: azithromycin are equally effective in the treatment of uncomplicated typhoid fever. 02/01/2018 Key words: Typhoid Fever, Azithromycin, Ciprofloxacin, Clinical Cure, Bacteriological Cure, Clinical Failure, Bacteriological Failure, Resistance. Article Citation: Ali K, Hussain S, Akhter MS, Uncomplicated typhoid fever; Comparison of azithromycin and ciprofloxacin in the treatment. Professional Med J 2018;25(1):150-155. DOI:10.29309/TPMJ/18.4014 INTRODUCTION laboratory tests like leucopenia, typhidot test, Typhoid fever can be defined as a systemic disease widal test, blood, stool or bone marrow culture characterized by fever and gastrointestinal do help in confirmation in suspected cases. manifestations caused by dissemination of Widespread emergence of multidrug resistant Salmonella typhi.1 Typhoid fever is a global health strains of Salmonella typhi has necessitated problem. Sypmtoms of typhoid fever include fever the search for other therapeutic options.2 ascending in stepwise fashion, malaise, headache Flouroquinolones have proved to be effective, abdominal pain, constipation, abdominal but quinolone resistant strains of Salmonella distension and other constitutional symptoms. have been reported.3 Azithromycin has better Physical findings are raised temperature, relative activity against gram negative bacteria including bradycardia, spleenomegaly, hepatomegaly, Salmonella typhi.4 In an open randomized trial in abdominal tenderness, meningism and in some Egypt, it was concluded that azithromycin and patients rose spots. Major complications include ciprofloxacin were equally effective, both clinically intestinal hemorrhage, intestinal perforation, and bacterilogically, against typhoid fever caused urinary retention, pneumonia, thrombophlebitis, by both sensitive and multi drug resistant strains myocarditis, cholecystitis, nephritis, myocarditis, of Salmonella typhi.5 This prompted the current osteomyelitis and meningitis. Diagnosis of study of azithromycin versus typhoid fever in the typhoid fever is mostly clinical however several treatment of uncomplicated typhoid fever at DHQ Professional Med J 2018;25(1):150-155. www.theprofesional.com 150 UNCOMPLICATED TYPHOID FEVER 2 / Teaching Hospital Dera Ghazi Khan. four times a day and a daily physical examination was performed to detect any improvement or MATERIALS AND METHODS development of a complication for ten days. It was a Quasi Experimental Study conducted at Blood or stool cultures were repeated at day ten department of Medicine, DHQ/ Teaching Hospital of therapy in culture positive cases. In our study Dera Ghazi Khan from April 2016 to September clinical cure was defined as resolution of fever and 2016. A total of 60 patients including both males other presenting symptoms by the end of seven and females over 18 years of age were included in days of therapy and clinical failures was defined as the study by Simple random probability sampling. the lack of resolution of fever and other presenting For patients presenting within first week of onset symptoms by the end of seven days of therapy or of fever the inclusion criteria were any two out of development of a major complication of typhoid following three: fever after the start of therapy. Bacteriological 1. Documented continuous fever of > 38 oC cure was defined as a negative blood or stool 2. Positive typhoid test culture at day 10 of therapy and Bacteriological 3. Positive blood culture for Salmonella typhi. failure was defined as a positive blood or stool culture at day 10 of therapy. Findings about age, For patients presenting in the second week of sex, clinical features, laboratory results, clinical onset of fever the inclusion criteria were any two cure or failure and bacteriological cure or failure out of following three: were recorded in a predesigned Performa. Main 1. Strong clinical suspicion based on features variables which were measured included age and like documented continuous fever of more sex distribution, clinical cure (achieved or not), than 38oC, abdominal pain, spleenomegaly bacteriological cure (achieved or not) and any and rose spots. differences in the clinical and bacteriological cure 2. Positive Widal T:O titres of equal to or more rates among two groups. All the data was entered than 1:160 into and analyzed by the computer programme 3. Positive stool culture for Salmonella. SPSS. Frequency, percentages, mean values and standard deviations were calculated for age, Exclusion criteria included pregnancy, lactation, sex, symptoms, signs and culture reports. Chi- allergy to ciprofloxacin or azithromycin, presence square test was applied to compare the results of any major complication of typhoid fever, of two groups. A p value of less than 0.05 was inability to swallow oral medications, presence considered significant. of focal signs likely to explain other causes of fever and treatment within last four days with an RESULTS antibiotic potentially active against Salmonella Out of 60 patients 39 (65%) were males and typhi. Informed consent was obtained before 21(35%) were females. No patient expired or was including patients in the study. Patients fulfilling excluded from the study. All the patients had good the inclusion criteria were divided in two equal follow-up till the recommended period. Mean age groups of 30 by using the random numbers table. was 22.10(+/- S.D 7.2) years (Table-I). All 60 First group was labeled as Azithromycin group patients were febrile at the time of presentation and was treated with azithromycin one gram and both groups were comparable as for as the on day one and then 500 mg daily for next six mean duration of fever is concerned. Headache days. Second group was labeled as Ciprofloxacin was the second most frequent symptom, in 52 group and was treated with ciprofloxacin 500mg (86.6%) patients, followed by nausea or vomiting twice daily for ten days. All the patients were which were present in 46 (76.6%) patients. In assessed by detailed clinical history and physical the physical signs, fever of variable degrees was examination. Specific investigations like widal test recorded in all 60 patients. Relative bradycardia or typhidot test, blood or stool culture were also was present in only 32 (53.3%) patients. Other sent depending upon the duration of fever before frequent findings on physical examination the start of treatment. Temperature was recorded were spleenomegaly in 28(46.6%) patients and Professional Med J 2018;25(1):150-155. www.theprofesional.com 151 UNCOMPLICATED TYPHOID FEVER 3 hepatomegaly in 16 (26.6%) patients. Table-II and (92.3%) patients and the organism disappeared III give the detailed statistics about the symptoms from the blood or stool on day 10 of therapy. In and signs of the patients included in study. ciprofloxacin group, bacteriological response was achieved in 25 (96.15%) patients and the There were 35(58.3%) patients who presented in organism disappeared on day. The results of first week of onset of fever. Typhidot test was done the two groups were compared by applying chi- in all of them it turned to be positive in 34 patients. square test. There was no significant statistical 35(58.3%)
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