Trial reportPLoS neglected tropical diseases2018
Open label comparative trial of mono versus dual antibiotic therapy for Typhoid Fever in adults.
Trial report in PLoS neglected tropical diseases, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02224040 (Typhoid Fever), which is not on this map. Cited by 15 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.
Typhoid Fever: Combined vs. Single Antibiotic Therapy. A Prospective Randomized Controlled Study in Nepal.
Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it, 36 citations in OpenAlex.
- Treatment of enteric fever (typhoid and paratyphoid fever) with cephalosporins.The Cochrane database of systematic reviews · 2022Pooled it
- Plasma and Intracellular Concentrations of Doxycycline and Azithromycin in Patients with Severe Scrub Typhus.Antibiotics (Basel, Switzerland) · 2026Article
- Typhoid fever.Nature reviews. Disease primers · 2023Review
- A pattern of antibiotic drug resistance of Salmonella Typhi and Salmonella Paratyphi among children with enteric fever in a tertiary care hospital in Lahore, Pakistan.Croatian medical journal · 2023Article
- Salmonella typhimurium necrotizing fasciitis: a case report.Journal of medical case reports · 2023Article
- What Should We Be Recommending for the Treatment of Enteric Fever?Open forum infectious diseases · 2023Article
- Leveraging laboratory and clinical studies to design effective antibiotic combination therapy.Current opinion in microbiology · 2021Review
- Evaluation of Antimicrobial Susceptibility Profile in Salmonella Typhi and Salmonella Paratyphi A: Presenting the Current Scenario in India and Strategy for Future Management.The Journal of infectious diseases · 2021Article
- Azithromycin and cefixime combination versus azithromycin alone for the out-patient treatment of clinically suspected or confirmed uncomplicated typhoid fever in South Asia: a randomised controlled trial protocol.Wellcome open research · 2021Article
- Response of extensively drug resistant Salmonella Typhi to treatment with meropenem and azithromycin, in Pakistan.PLoS neglected tropical diseases · 2020Article
- Case Report: Typhoid Fever Complicated by Acute Respiratory Distress Syndrome in a Pediatric Traveler.The American journal of tropical medicine and hygiene · 2019Article
- Cardiac Involvement in Travelers with Enteric Fever.The American journal of tropical medicine and hygiene · 2019Article
- Current antibiotic use in the treatment of enteric fever in children.The Indian journal of medical research · 2019Article
- Relapse of typhoid fever following delayed response to meropenem: A case report and review of previously published cases indicating limited clinical efficacy of meropenem for the treatment of typhoid fever.German medical science : GMS e-journal · 2019Review
- The epidemiology of typhoid fever in the Dhulikhel area, Nepal: A prospective cohort study.PloS one · 2018Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundEmerging resistance to antibiotics renders therapy of Typhoid Fever (TF) increasingly challenging. The current single-drug regimens exhibit prolonged fever clearance time (FCT), imposing a great burden on both patients and health systems, and potentially contributing to the development of antibiotic resistance and the chronic carriage of the pathogens. The aim of our study was to assess the efficacy of combining third-generation cephalosporin therapy with azithromycin on the outcomes of TF in patients living in an endemic region.
methodsAn open-label, comparative trial was conducted at Dhulikhel Hospital, Nepal, between October 2012 and October 2014. Only culture-confirmed TF cases were eligible. Patients were alternately allocated to one of four study arms: hospitalized patients received either intravenous ceftriaxone or a combination of ceftriaxone and oral azithromycin, while outpatients received either oral azithromycin or a combination of oral azithromycin and cefexime. The primary outcome evaluated was FCT and the secondary outcomes included duration of bacteremia.
results105 blood culture-confirmed patients, of whom 51 were treated as outpatients, were eligible for the study. Of the 88 patients who met the inclusion criteria for FCT analysis 41 patients received a single-agent regimen, while 47 patients received a combined regimen. Results showed that FCT was significantly shorter for the latter (95 versus 88 hours, respectively, p = 0·004), and this effect was exhibited in both the hospitalized and the outpatient sub-groups. Repeat blood cultures, drawn on day 3, were positive for 8/47 (17%) patients after monotherapy, versus 2/51 (4%) after combination therapy (p = 0·045). No severe complications or fatalities occurred in any of the groups.
conclusionsCombined therapy of third-generation cephalosporins and azithromycin for TF may surpass monotherapy in terms of FCT and time to elimination of bacteremia.
trial registrationTrial registration number: NCT02224040.
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