Comparing the Efficacy of Amoxicillin and Ceftriaxone in Clinical Management of Uncomplicated Enteric Fever in Children: A Cost-effective Approach in Bangladesh

Abstract

Background: Enteric fever (EF) is a systemic and often a fatal infection caused by Salmonella enteric serotype typhi. EF poses a significant public health challenge in Bangladesh. Uncomplicated susceptibility to EF can be defined as a clinical diagnosis of typhoid or paratyphoid fever without excessive toxemia, gastrointestinal hemorrhage or perforation, shock, or neuropsychiatric complications. S. typhi, characterized by resistance to 3 (three) primary antibiotics used in typhoid treatment: chloramphenicol, ampicillin, and cotrimoxazole necessitated the search for a suitable alternative typhi susceptibility to amoxicillin, which could be a safe, cost-effective and suitable drug. Objective: We evaluated the efficacy of amoxicillin and ceftriaxone to compare the treatment status against uncomplicated-EF in children thus to guide in selectivity, safety, effectiveness, readily available alternate, better therapeutic measure and potentially reduced overall treatment cost. Methodology: In this cross-sectionally designed comparative study, we enrolled 96 children with clinically diagnosed uncomplicated-EF admitted at the department of Pediatrics, SSMCH. Of total 96 children, 48 were placed in the amoxicillin Group (Gp-A) and another 48 in ceftriaxone Group (Gp-B). Age, sex and socioeconomic condition of child’s households/families were recorded to compare findings between A and B Group of children. Period of defervescence, hospital stay, treatment outcome, adverse effects, and cost of drugs were compared between these two Groups (A and B). Results: Slight male preponderance was observed. Most children came from families of a low socio-economic class. A shorter defervescence period, duration of treatment and hospital stay was noted in the Ceftriaxone Group. The mean period of defervescence was 5.11 ± 1.90 days in Group A, while in the other Group it was 5.55±0.45 days - which is not statistically significant (P>0.05). In the Amoxicillin Group, the duration of treatment was 12.80± 1.20 days and the mean hospital stay was 12.20±1.8 days. Whereas, in the Ceftriaxone Group children received treatment for 8.70± 1.30 days on average and were inpatients for 9.13±0.87 days. Both the findings for treatment duration and hospital stay were statistically significant (p<0.05). 73% of patients receiving Amoxicillin were cured but 100% of those in Group B were cured. Treatment with Amoxicillin is significantly more cost-effective than Ceftriaxone. 63.83% and 2.13% of the isolates were resistant to Amoxicillin and Ceftriaxone respectively. No serious adverse effects were noted. Conclusion: Ceftriaxone showed better efficacy (100% clinical sure rate) shorter defervescence period and shorter hospital stay, though no major difference was revealed. Amoxicillin remained comparable to that of ceftriaxone in treating uncomplicated EF in children yielding a high cure rate being comparable to that of ceftriaxone. Furthermore, amoxicillin appeared to be a safe choice including total treatment cost (~81% lower than that of Ceftriaxone). The Journal of Ad-din Women's Medical College; Vol. 11 (1), Jan 2023; p 14-21