To Study the Effectiveness of Oral Azithromycin as Compared to Parenteral Ceftriaxone in the Treatment of Uncomplicated Enteric Fever

Nagaraj, P; Sivathanu, Shobhana; Manickam, Kumar; Kumar, Satheesh; Kumar, Sunder; Sampath, Sowmya

doi:10.1055/s-0036-1593889

Cited by 3 publications

(2 citation statements)

References 9 publications

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“…Six studies met the criteria for inclusion and subsequent data extraction. The six studies ( 13,14,15,16,17,18 ) included 520 patients. The risk of bias assessment of all six trials was generally low risk (Figure 1).…”

Section: Resultsmentioning

confidence: 99%

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Oral Azithromycin Vs Intravenous Ceftriaxone in the Treatment of Enteric Fever: A Systematic Review and Meta-Analysis

Sy¹,

Ty²

2020

PIDSPJ

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Background: Typhoid fever, also known as enteric fever, is a severe systemic illness characterized by fever and gastrointestinal manifestations that commonly affects children and young adults. It is most prevalent in SouthCentral Asia, Southern Africa, and Southeast Asia. Alternative drugs for the treatment of enteric fever have been studied to decrease toxicity and increase compliance. Oral azithromycin has been proposed and is widely studied as a suitable treatment alternative. Objective: The objective of this study is to compare oral azithromycin with intravenous ceftriaxone in the treatment of uncomplicated typhoid fever in terms of cure, duration of fever, relapse, and adverse events. Methodology: A systematic review and meta-analysis were done with eligible studies taken from PUBMED, MEDLINE, and Cochrane Clinical Trial Registry. Six studies passed the eligibility criteria and were analyzed using Review Manager 5.3. Results: Azithromycin showed comparable results with ceftriaxone in terms of cure, duration of fever and adverse events. However, azithromycin proved superior in decreasing relapse. Conclusion: Azithromycin is comparable to ceftriaxone in the treatment of uncomplicated typhoid fever in terms of cure, duration of fever, and occurrence of adverse events. Azithromycin likewise had a lower incidence of relapse. Recommendations: We recommend conducting local trials in pediatric patients, to compare azithromycin with standard antibiotic regimen for typhoid fever, to help update local recommendations and expand choices for antibiotic use.

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Section: Resultsmentioning

confidence: 99%

“…This study aimed to investigate the efficacy of oral azithromycin against parenteral ceftriaxone in the treatment of uncomplicated typhoid fever, and whether intravenous drugs may be replaced with oral azithromycin for the convenience and for better compliance among pediatric patients [12][13][14][15][16][17][18][19][20][21] .…”

Section: Introductionmentioning

confidence: 99%

Oral Azithromycin Vs Intravenous Ceftriaxone in the Treatment of Enteric Fever: A Systematic Review and Meta-Analysis

Sy¹,

Ty²

2020

PIDSPJ

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Treatment of enteric fever (typhoid and paratyphoid fever) with cephalosporins

Kuehn

Stoesser

Eyre

et al. 2022

Cochrane Database of Systematic Reviews

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Background Typhoid and paratyphoid (enteric fever) are febrile bacterial illnesses common in many low‐ and middle‐income countries. The World Health Organization (WHO) currently recommends treatment with azithromycin, ciprofloxacin, or ceftriaxone due to widespread resistance to older, first‐line antimicrobials. Resistance patterns vary in different locations and are changing over time. Fluoroquinolone resistance in South Asia often precludes the use of ciprofloxacin. Extensively drug‐resistant strains of enteric fever have emerged in Pakistan. In some areas of the world, susceptibility to old first‐line antimicrobials, such as chloramphenicol, has re‐appeared. A Cochrane Review of the use of fluoroquinolones and azithromycin in the treatment of enteric fever has previously been undertaken, but the use of cephalosporins has not been systematically investigated and the optimal choice of drug and duration of treatment are uncertain. Objectives To evaluate the effectiveness of cephalosporins for treating enteric fever in children and adults compared to other antimicrobials. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL, MEDLINE, Embase, LILACS, the WHO ICTRP and ClinicalTrials.gov up to 24 November 2021. We also searched reference lists of included trials, contacted researchers working in the field, and contacted relevant organizations. Selection criteria We included randomized controlled trials (RCTs) in adults and children with enteric fever that compared a cephalosporin to another antimicrobial, a different cephalosporin, or a different treatment duration of the intervention cephalosporin. Enteric fever was diagnosed on the basis of blood culture, bone marrow culture, or molecular tests. Data collection and analysis We used standard Cochrane methods. Our primary outcomes were clinical failure, microbiological failure and relapse. Our secondary outcomes were time to defervescence, duration of hospital admission, convalescent faecal carriage, and adverse effects. We used the GRADE approach to assess certainty of evidence for each outcome. Main results We included 27 RCTs with 2231 total participants published between 1986 and 2016 across Africa, Asia, Europe, the Middle East and the Caribbean, with comparisons between cephalosporins and other antimicrobials used for the treatment of enteric fever in children and adults. The main comparisons are between antimicrobials in most common clinical use, namely cephalosporins compared to a fluoroquinolone and cephalosporins compared to azithromycin. Cephalosporin (cefixime) versus fluoroquinolones Clinical failure, microbiological failure and relapse may be increased in patients treated with cefixime compared to fluoroquinolones in three small trials published over 14 years ago: clinical failure (risk ratio (RR) 13.39...

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Length of hospital stay and associated treatment costs for patients with susceptible and antibiotic-resistant Salmonella infections: systematic review and meta-analysis

Kim,

Frost,

Naylor

et al. 2024

Preprint

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Background The global disease burden of Salmonella infections in 2017 included 135,900 deaths caused by Salmonella Typhi and Paratyphi and 77,000 deaths caused by invasive non-typhoidal Salmonella, and increasing antimicrobial resistance further exacerbates morbidity, mortality, and costs. To address the evidence gap on the economic burden of antimicrobial resistant Salmonella infections, our study aim is to estimate the estimate the length of hospital stay and associated treatment costs for patients with susceptible or antibiotic-resistant Salmonella Typhi, Paratyphi, and non-typhoidal Salmonella infections. Methods We conducted a systematic review by searching EMBASE, Medline, Scopus, Hinari, and LILACS databases for studies published between January 1, 2005 and December 17, 2021, with no language restrictions. We identified studies that reported on length of hospital stay and associated treatment costs for patients with susceptible or antibiotic-resistant Salmonella Typhi, Paratyphi, and non-typhoidal Salmonella infections. We converted monetary costs to 2019 USD and pooled estimates by quantile level of GDP per capita using random effects meta-analysis. We assessed the quality of included studies using critical appraisal tools from the Joanna Briggs Institute. Results We included 26 studies in our systematic review, and the mean quality scores ranged from 0.55 to 1.00 across different study designs. Patients with drug-resistant Salmonella infections had significantly longer hospital stays, with an additional 0.5–2.2 days compared to drug-susceptible Salmonella infections. The direct hospitalisation costs for drug-resistant typhoidal Salmonella were 71–103% higher than for drug-susceptible typhoidal Salmonella infections in the same setting. The mean hospital stay was 5.9 days (95% CI: 4.4, 7.5) for drug-susceptible typhoidal Salmonella infections, while it was 7 days (95% CI: 4.7, 9.3) for resistant typhoidal Salmonella infections in the lowest income quintile. Conclusions While the length of hospital stay and associated treatment costs for patients with antibiotic-resistant Salmonella infections varied by pathogen, country, and resistance level, they were higher in comparison to antibiotic-susceptible Salmonella infections. However, evidence on length of hospital stay and treatment costs are lacking from typhoid-endemic regions of sub-Saharan Africa.

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To Study the Effectiveness of Oral Azithromycin as Compared to Parenteral Ceftriaxone in the Treatment of Uncomplicated Enteric Fever

Cited by 3 publications

References 9 publications

Oral Azithromycin Vs Intravenous Ceftriaxone in the Treatment of Enteric Fever: A Systematic Review and Meta-Analysis

Oral Azithromycin Vs Intravenous Ceftriaxone in the Treatment of Enteric Fever: A Systematic Review and Meta-Analysis

Treatment of enteric fever (typhoid and paratyphoid fever) with cephalosporins

Length of hospital stay and associated treatment costs for patients with susceptible and antibiotic-resistant Salmonella infections: systematic review and meta-analysis

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