A meta-analysis comparing the safety and efficacy of azithromycin over the alternate drugs used for treatment of uncomplicated enteric fever.
N A Trivedi,P C Shah +1 more
TLDR
Azithromycin can be recommended as a second-line drug in MDR typhoid fever, however, large trials involving pediatric age group patients are recommended to arrive at a definite conclusion.Abstract:
Background: Drug-resistant typhoid fever is a major clinical problem globally. Emergence of multidrug-resistant (MDR) S. Typhi has complicated therapy by limiting treatment options. Objectives: A meta-analysis was planned to determine the strength of evidence supporting use of azithromycin over the alternate drugs available for treatment of uncomplicated typhoid fever. Materials and Methods: Studies were identified using electronic database such as MEDLINE and other data at the National Library of Medicine assessed using PUBMED search engine as well as Cochrane Clinical Trial Register. Randomized control trials (RCTs) comparing azithromycin with chloramphenicol, fluoroquinolones and cephalosporins in culture-proven enteric fever were included. Data was extracted and methodological quality was assessed. Risk ratio (RR) with 95% confidence intervals was estimated for the dichotomous outcomes and mean difference (MD) with 95% confidence was estimated for continuous data. Primary outcomes studied were clinical failure (CF), microbiological failure, and relapse. Results: A total of seven RCTs involving 773 patients met with our inclusion criteria. In comparison to older fluoroquinolones, azithromycin is marginally better in reducing the chance of CF with RR 0.46 (95% CI 0.25-0.82), while in comparison to ceftriaxone, it significantly reduced the chance of relapse with RR 0.1 (95% CI 0.01- 0.76). There were no serious adverse events reported in any of the trials. Conclusion: Azithromycin can be recommended as a second-line drug in MDR typhoid fever, however, large trials involving pediatric age group patients are recommended to arrive at a definite conclusion.read more
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Journal ArticleDOI
Epidemiology, Clinical Presentation, Laboratory Diagnosis, Antimicrobial Resistance, and Antimicrobial Management of Invasive Salmonella Infections
TL;DR: Azithromycin is effective for the management of uncomplicated typhoid fever and may serve as an alternative oral drug in areas where fluoroquinolone resistance is common and ciprofloxacin susceptibility breakpoints were lowered to account for accumulating clinical, microbiologic, and pharmacokinetic-pharmacodynamic data.
Journal ArticleDOI
Macrolide resistance mechanisms in Enterobacteriaceae: Focus on azithromycin
Cláudia Gomes,Sandra Martínez-Puchol,Noemí Palma,Gertrudis Horna,Lidia Ruiz-Roldán,Maria J. Pons,Joaquim Ruiz +6 more
TL;DR: The present review is focused on the mechanisms of macrolide resistance, currently described in Enterobacteriaceae, and the facility that this bacterial genus has to gain or develop mechanisms of antibiotic resistance may compromise the future usefulness of these antibiotics to fight against Enterobacteria.
Journal ArticleDOI
The evolution of antimicrobial resistance in Salmonella Typhi.
TL;DR: Good surveillance, improved diagnostics, more prudent use of antimicrobials, and effective vaccines will all be critical to reducing the burden of disease caused by S. Typhi.
Journal ArticleDOI
Tropical fevers: Management guidelines.
Sunit Singhi,Dhruva Chaudhary,George M. Varghese,Ashish Bhalla,N. Karthi,Shriprakash Kalantri,John Victor Peter,Rajesh C Mishra,Rajesh Bhagchandani,Manish Munjal,TD Chugh,Narendra Rungta +11 more
TL;DR: The committee recommends a ‘syndromic approach’ to diagnosis and treatment of critical tropical infections and has identified five major clinical syndromes: undifferentiated fever, fever with rash / thrombocytopenia, Fever with acute respiratory distress syndrome (ARDS), fever with encephalopathy and fever with multi organ dysfunction syndrome.
Journal ArticleDOI
Multidrug resistant enteric fever in South Asia: unmet medical needs and opportunities
Christopher M. Parry,Christopher M. Parry,Isabela Ribeiro,Kamini Walia,Priscilla Rupali,Stephen Baker,Stephen Baker,Buddha Basnyat,Buddha Basnyat +8 more
TL;DR: Investments in newer diagnostics and antimicrobial treatments are critical to improve management of enteric fever in South Asia, say Christopher Parry and colleagues.
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