Trial reportClinical infectious diseases : an official publication of the Infectious Diseases Society of America2017
Treatment Response in Enteric Fever in an Era of Increasing Antimicrobial Resistance: An Individual Patient Data Analysis of 2092 Participants Enrolled into 4 Randomized, Controlled Trials in Nepal.
Trial report in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 23 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
23 citing papers in PubMed, 1 synthesis or guideline pooled it, 54 citations in OpenAlex.
- Drug-resistant enteric fever worldwide, 1990 to 2018: a systematic review and meta-analysis.BMC medicine · 2020Pooled it
- Comparative immune response of Typbar TCV® (typhoid conjugate vaccine) in extremes of age: An Indian experience.Human vaccines & immunotherapeutics · 2025Trial
- Trimethoprim-sulfamethoxazole Versus Azithromycin for the Treatment of Undifferentiated Febrile Illness in Nepal: A Double-blind, Randomized, Placebo-controlled Trial.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021Trial
- Open label comparative trial of mono versus dual antibiotic therapy for Typhoid Fever in adults.PLoS neglected tropical diseases · 2018Trial
- Efficacy and immunogenicity of a Vi-tetanus toxoid conjugate vaccine in the prevention of typhoid fever using a controlled human infection model of Salmonella Typhi: a randomised controlled, phase 2b trial.Lancet (London, England) · 2017Trial
- Trial
- A novel framework for quantifying the clinical impact of substandard and falsified antimicrobials: Application to typhoid fever.PLOS global public health · 2026Article
- Article
- Tissue compartmentalization enablesProceedings of the National Academy of Sciences of the United States of America · 2021Article
- Typhoid and Enteric Fevers in Intensive Care Unit.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2021Article
- Antimicrobial Resistance inMicrobiology insights · 2021Article
- Spatial Heterogeneity of Enteric Fever in 2 Diverse Communities in Nepal.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2020Article
- A whole-genome screen identifies Salmonella enterica serovar Typhi genes involved in fluoroquinolone susceptibility.The Journal of antimicrobial chemotherapy · 2020Article
- Case Report:The American journal of tropical medicine and hygiene · 2020Article
- Fever in travellers returning from the tropics.Medicina clinica · 2019Review
- Fever in travellers returning from the tropics.Medicina clinica (English ed.) · 2019Review
- A Global Agenda for Typhoid Control-A Perspective from the Bill & Melinda Gates Foundation.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2019Article
- Typhoid and paratyphoid fever: a call to action.Current opinion in infectious diseases · 2018Review
- The Burden of Typhoid Fever in South Africa: The Potential Impact of Selected Interventions.The American journal of tropical medicine and hygiene · 2018Article
- Fluoroquinolone resistance in Salmonella: insights by whole-genome sequencing.Microbial genomics · 2018Review
Corrections and comments
- Erratum issuedErratum.2017
Authors and funding
11 authors at 3 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND.: Enteric fever, caused by Salmonella Typhi and Salmonella Paratyphi A, is the leading cause of bacterial febrile disease in South Asia. METHODS.: Individual data from 2092 patients with enteric fever randomized into 4 trials in Kathmandu, Nepal, were pooled. All trials compared gatifloxacin with 1 of the following comparator drugs: cefixime, chloramphenicol, ofloxacin, or ceftriaxone. Treatment outcomes were evaluated according to antimicrobial if S. Typhi/Paratyphi were isolated from blood. We additionally investigated the impact of changing bacterial antimicrobial susceptibility on outcome. RESULTS.: Overall, 855 (41%) patients had either S. Typhi (n = 581, 28%) or S. Paratyphi A (n = 274, 13%) cultured from blood. There were 139 (6.6%) treatment failures with 1 death. Except for the last trial with ceftriaxone, the fluoroquinolone gatifloxacin was associated with equivalent or better fever clearance times and lower treatment failure rates in comparison to all other antimicrobials. However, we additionally found that the minimum inhibitory concentrations (MICs) against fluoroquinolones have risen significantly since 2005 and were associated with increasing fever clearance times. Notably, all organisms were susceptible to ceftriaxone throughout the study period (2005-2014), and the MICs against azithromycin declined, confirming the utility of these alternative drugs for enteric fever treatment. CONCLUSION.: The World Health Organization and local government health ministries in South Asia still recommend fluoroquinolones for enteric fever. This policy should change based on the evidence provided here. Rapid diagnostics are urgently required given the large numbers of suspected enteric fever patients with a negative culture.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.