Chloramphenicol Combined with Ampicillin in Treatment of Typhoid

Fifty out of 100 patients with typhoid fever, matched for age, stage of illness, and degree of fever, were treated with chloramphenicol and the other 50 were treated with chloramphenicol combined with ampicillin. The febrile period was shortened by up to 29% in patients treated with the combined drugs compared with those given only chloramphenicol. Moreover, no patient on combined therapy had a febrile relapse, whereas two relapses occurred among patients treated with chloramphenicol only. We conclude that chloramphenicol and ampicillin together are better than chloramphenicol alone in the treatment of typhoid fever.     

CHLORAMPHENICOL IN THE TREATMENT OF TYPHOID FEVER

Six patients with typhoid fever were treated with chloramphenicol. The excellent clinical response in four cases suggests that chloramphenicol is the drug of choice in the treatment of this disease. In one case in which clinical relapse occurred, there was good response to re-treatment. One patient, critically ill, in a typhoid state, and treated late in the course of the disease, died without beneficial effect from chloramphenicol, but the patient had been unable to retain the drug because of vomiting.     

Trimethoprim and Sulphamethoxazole in Typhoid Fever in Children

One hundred and three children with proved typhoid fever were treated with trimethoprim-sulphamethoxazole, and the results compared with those of a further 40 children treated with chloramphenicol. The bacteriological response to trimethoprim-sulphamethoxazole was unsatisfactory. From this study it seems that at present chloramphenicol is still the treatment of choice for typhoid fever. In view of the haematological changes occurring during therapy with trimethoprim-sulphamethoxazole caution is necessary and monitoring of the blood picture advisable, even at the recommended dose.     

Comparative trial of Co-trimoxazole and Chloramphenicol in Typhoid Fever

A comparative trial of co-trimoxazole and chloramphenicol was conducted in two groups of 50 patients each to try to resolve conflicting opinions on the relative merits of the two drugs in the treatment of typhoid fever. We conclude that in our part of India co-trimoxazole is superior to chloramphenicol and that differences in our findings to those of others may perhaps be accounted for by differences in strains of Salmonella typhi, ethnic differences, and possibly differences in herd immunity to typhoid.     

Problems of etiotropic therapy of typhoid fever and approaches to their solution]

The main problems of etiotropic therapy for typhoid fever lie in underestimate of the characteristic features of its pathogenesis and particularly in development of typhoid granulomas and their histogenesis, as well as in wide spread of typhoid fever pathogenic strains resistant to the routine chemotherapeutics, i.e. polyresistant strains. Some problems are due to incorrect choice of the antimicrobials and their combinations, optimal doses, administration routes and pathogenetic therapy. In the XXth centure an increase in the emergence and a change in the nature of the typhoid fever pathogen resistance to antimicrobials were observed. It was shown that from the pharmacologic and pharmacodynamic viewpoints the highest efficacy of typhoid fever therapy should be provided by the following antimicrobials: fluoroquinolones (except for norfloxacin), 3rd and 4th generation cephalosporins, aminopenicillins, chloramhenicol (levomycetin), combinations of 2nd and 3rd generation aminoglycosides with biseptol, aminopenicillins or doxycycline, as well as chloramphenicol combinations with aminopenicillins or 2nd to 4th generation cephalosporins. Practical recommendations for the etiotropic therapy of patients with typhoid fever during its outbreak or epidemic are presented.     

中枢神经系统奴卡菌感染诊治分析附一例鼻疽奴卡菌脑脓肿

目的:了解中枢神经系统(CNS)奴卡菌感染的临床特点、诊治方法及预后。方法:对青岛大学附属医院收治的1例脑奴卡菌感染病例进行报道,并检索相关文献报道的脑奴卡菌感染共31例,对以上32例进行回顾性分析。结果:32例患者中,22例存在基础疾病,18例有糖皮质激素或免疫抑制剂治疗史。主要临床表现为头痛,发热,恶心、呕吐,口齿不清,意识障碍,肢体功能障碍等。7例接受复方磺胺甲噁唑单药治疗,17例接受复方磺胺甲噁唑联合其他抗生素治疗,8例接受喹诺酮类、氨基糖苷类、β-内酰胺类等联合治疗。23例好转或治愈,9例死亡。结论:免疫功能低下是中枢神经系统奴卡菌病的危险因素;奴卡菌培养阳性是确诊该病的惟一方法;应及早应用磺胺类药物,必要时结合外科手术治疗。     

Typhoid outbreak in Kingston,Ont: experience with high-dose oral ampicillin.

Twenty-four children contracted typhoid fever at a summer camp near Kingston, Ont. Six were treated with chloramphenicol alone and 15 with high doses of ampicillin (300 mg/kg-d) by mouth. Ampicillin in this dosage was well tolerated except in three children in whom severe urticarial rashes developed and two who had significant diarrhea. However, high-dose oral ampicillin therapy had no advantage over that with lower doses or over chloramphenicol as judged by the rate of defervescence after the start of treatment, the rate of clinical relapse and the frequency of excretion of Salmonella typhi during convalescence.     

Molecular characterization of antibiotic resistance in clinical Salmonella typhi isolated in Ghana

Fifty-eight clinical Salmonella typhi strains isolated from patients suspected of suffering from typhoid fever were obtained at the Korle-Bu Teaching Hospital and the Noguchi Memorial Institute for Medical Research, both located in Ghana, Africa. Each isolate was examined for susceptibility to ampicillin, chloramphenicol, streptomycin, tetracycline, and trimethoprim/sulfamethoxazole by the disk diffusion assay. Five of the isolates were resistant to all five antibiotics while 10 isolates were resistant to ampicillin, chloramphenicol, and trimethoprim/sulfamethoxazole, which are considered 'first line' antibiotics in the treatment of typhoid fever. Thirty-four isolates were resistant to at least one of the antibiotics tested and 62% of these isolates possessed conjugable plasmids belonging to incompatibility group IncHI. Ninety percent of the conjugable plasmids conferred a multiple drug-resistant phenotype on the strains harboring them. Additionally, 14 strains contained plasmids that were transformable and six of them encoded multiple drug resistance. Our findings indicate that multiple drug resistance to the 'first line' antibiotics in S. typhi may be more prevalent in Africa than previously thought.     

Clinical Evaluation of Co-trimoxazole and Furazolidone in Treatment of Shigellosis in Children

Co-trimoxazole (trimethoprim—sulphamethoxazole) was compared with furazolidone in the treatment of shigellosis in two groups of 33 and 30 patients respectively. Those treated with co-trimoxazole recovered more quickly; none had shigellae in the faeces four days after the start of treatment, whereas in the group given furazolidone eight still had positive stool cultures seven days after treatment.The susceptibility of 104 shigella strains to seven antimicrobial agents was studied by plate dilution technique. All agents but tetracycline and chloramphenicol were found highly effective against most of the strains tested. All shigella isolates were resistant to sulphamethoxazole, and 63% were sensitive to trimethoprim. Potentiation of trimethoprim by sulphamethoxazole was shown in that all strains tested became sensitive to the combination of trimethoprim and sulphamethoxazole in a ratio of 1:20.     

Comparative Trial of Tetracycline,Chloramphenicol, and Trimethoprim Sulphamethoxazole in Eradication of Vibrio cholera El Tor

A comparison of tetracycline, chloramphenicol, and trimethoprim/sulphamethoxazole showed that all hasten the eradication of Vibrio cholerae from the stools of patients with cholera.A four-day period of tetracycline or trimethoprim/ sulphamethoxazole was adequate for eradicating V. cholerae from the stools of all patients, but three days, as suggested by the W.H.O. Expert Committee, was not. Four days of chloramphenicol therapy was sufficient for most patients, but a minority required up to seven days'' therapy.Purging produced reappearance of V. cholerae in the stools of one-eighth of the patients who had had three successive daily negative stool cultures; such patients are a potential danger to the population.     

Potentiation of Inhibitory Activity of Colistin on Pseudomonas aeruginosa by Sulphamethoxazole and Sulphamethizole

Potentiation of colistin by sulphamethoxazole and sulphamethizole was demonstrated with 19 out of 20 strains of Pseudomonas aeruginosa. This enhancement was bactericidal as well as bacteriostatic. Synergy between trimethoprim and sulphamethoxazole was also demonstrated with four strains of Ps. aeruginosa, but even when the two drugs were combined high concentrations of trimethoprim were still required to produce a bactericidal effect. Combinations of sulphamethoxazole and gentamicin appeared to be synergistic when the bacteriostatic effect was measured, but the combined bactericidal effect was indifference. The bactericidal and bacteriostatic effect of combinations of carbenicillin with sulphamethoxazole was also indifference.     

Prevalence of multi-drug resistant Salmonella typhi among clinically diagnosed typhoid fever patients in Lagos, Nigeria

A total of 635 clinically diagnosed typhoid fever patients were bled from three different health institutions in the metropolis of Lagos, Nigeria over a period of 15 months, May 1997 to July 1998. Out of the total blood cultured, 101 (15.9%) isolates of Salmonella species were isolated of which 68 (67.3%) were S. typhi, 17 (16.8%) and 16 (15.8%) were S. paratyphi A. and S. arizonae respectively. The overall isolation rate of S. typhi among patients is 10.7%, with most isolates 45.9% found among the severely-ill young adults, age group 16-30 years. All isolates were subjected to anti-microbial susceptibility testing using 12 different antibiotics: chloramphenicol, ampicillin, cotrimoxazole, gentamicin, colistin sulfate, nalidixic acid, nitrofurantoin, cefotaxime, tetracycline, streptomycin, ofloxacin and ciprofloxacin. All the S. typhi and S. paratyphi A isolates showed resistance to two or more of the 10 of 12 antibiotics tested particularly the 3-first-line antibiotics commonly used (chloramphenicol, ampicillin and cotrimoxazole) in the treatment of typhoid fever in Nigeria. No isolate showed resistance to ofloxacin and ciprofloxacin, however, nalidixic acid and gentamicin showed a moderate and appreciable inhibition to most of our isolates.     

Clinical and Epidemiological Features of Typhoid Fever in Pemba,Zanzibar: Assessment of the Performance of the WHO Case Definitions

Background

The gold standard for diagnosis of typhoid fever is blood culture (BC). Because blood culture is often not available in impoverished settings it would be helpful to have alternative diagnostic approaches. We therefore investigated the usefulness of clinical signs, WHO case definition and Widal test for the diagnosis of typhoid fever.

Methodology/Principal Findings

Participants with a body temperature ≥37.5°C or a history of fever were enrolled over 17 to 22 months in three hospitals on Pemba Island, Tanzania. Clinical signs and symptoms of participants upon presentation as well as blood and serum for BC and Widal testing were collected. Clinical signs and symptoms of typhoid fever cases were compared to other cases of invasive bacterial diseases and BC negative participants. The relationship of typhoid fever cases with rainfall, temperature, and religious festivals was explored. The performance of the WHO case definitions for suspected and probable typhoid fever and a local cut off titre for the Widal test was assessed. 79 of 2209 participants had invasive bacterial disease. 46 isolates were identified as typhoid fever. Apart from a longer duration of fever prior to admission clinical signs and symptoms were not significantly different among patients with typhoid fever than from other febrile patients. We did not detect any significant seasonal patterns nor correlation with rainfall or festivals. The sensitivity and specificity of the WHO case definition for suspected and probable typhoid fever were 82.6% and 41.3% and 36.3 and 99.7% respectively. Sensitivity and specificity of the Widal test was 47.8% and 99.4 both forfor O-agglutinin and H- agglutinin at a cut-off titre of 1∶80.

Conclusions/Significance

Typhoid fever prevalence rates on Pemba are high and its clinical signs and symptoms are non-specific. The sensitivity of the Widal test is low and the WHO case definition performed better than the Widal test.     

莫西沙星治疗78 例伤寒的临床疗效观察

目的:探讨莫西沙星在伤寒治疗中的临床意义。方法:将我院2008年6月至2010年6月期间78例确诊的伤寒患者随机分为治疗组(39例)和对照组(39例),治疗组给予莫西沙星,对照组给予盐酸左氧氟沙星,均静脉滴注,每日1次,体温正常后7 d停药。结果:治疗组痊愈率94.8%,总有效率100%;对照组痊愈率92.3%,总有效率100%,两组痊愈率差异无统计学意义(P<0.05);治疗组开始退热和体温降至正常的时间均较对照组缩短,差异有显著意义(P<0.05)。治疗组不良反应发生率明显低于对照组(P<0.05)。结论:莫西沙星在伤寒治疗中具有疗效确切、无复发、副作用少等特点,在治疗非耐药和耐药伤寒中有重要作用,有较好的临床应用前景。     

Typhoid fever: facing the challenge of resistant strains

The introduction of chloramphenicol in 1948 revolutionised the outcome of typhoid fever but chloramphenicol-resistant strains of Salmonella enterica serotype Typhi were reported just two years later. Resistance followed also the introduction of ampicillin and co-trimoxazole. During the second half of the 1980s, strains resistant to the three first-line antimicrobial agents, chloramphenicol, ampicillin and co-trimoxazole emerged and spread rapidly throughout the Indian subcontinent and South East Asia. During the 1990s when fluoroquinolones had become a first-line treatment for typhoid fever, these multi drug resistant (MDR) strains acquired an additional resistance to nalidixic acid with decreased susceptibilities to ciprofloxacin (CIPDS) (MIC range, 0.125-1 mg/l). Considerable data have now accumulated to suggest that infections due to CIPDS strains may not respond satisfactorily to therapy with ciprofloxacin or ofloxacin. Furthermore, identification of such CIPDS strains in clinical laboratories is not easy without determination of MIC of ciprofloxacin. Recently, several isolates highly resistant to ciprofloxacin or to extended-spectrum cephalosporins of Asian origin have been reported.     

Mecillinam: a new antibiotic for enteric fever.

Mecillinam is a new antibiotic related to the penicillins but more active than ampicillin against salmonellae, including Salmonella typhi. Mecillinam must be administered parenterally, but the ester, pivmecillinam, is absorbed from the gut. Eight patients suffering from typhoid fever and one suffering from paratyphoid fever were treated with the antibiotic, and seven responded satisfactorily. One patient could not tolerate pivmecillinam because of vomiting but there were no other adverse reactions. Serum and bile levels of mecillinam were many times the minimum inhibitory concentrations for most salmonellae. The antibiotic is a promising addition to the agents available for treating typhoid.     

Transient inhibition of glucose utilization by erythrocytes during the acute stage of typhoid fever

The exact reason for hemolysis of glucose-6-phosphate dehydrogenase-deficient (G6PD) erythrocytes in patients with typhoid fever is unknown. Therefore, glucose utilization by normal and G6PD-deficient erythrocytes was measured during incubation with plasma of healthy controls as well as from patients in acute or recovery stages of typhoid fever. Glucose utilization in normal and G6PD-deficient erythrocytes significantly decreased compared to the controls when incubated with plasma of patients with acute typhoid fever, which normalized to the baseline after recovery from typhoid fever, suggesting an acquired alteration in G6PD enzyme properties by Salmonella typhi or its endotoxins.     

Evaluation of Trimethoprim-sulphamethoxazole Compound in Treatment of Salmonella Infections

Fifty patients suffering from infections caused by various salmonella species were treated with trimethoprim-sulphamethoxazole compound. Twenty-three had enteric fever and two were biliary carriers of Salmonella typhi. The other 25 suffered from infections caused by salmonella species other than S. typhi or S. paratyphi B. Twenty-one of the patients with enteric fever responded clinically to the drug, one failed treatment, and one died. Two patients suffering from typhoid fever relapsed and three temporarily excreted S. typhi in stools following treatment. One of the typhoid carriers was successfully treated. All patients with infections caused by salmonella species other than S. typhi or S. paratyphi B responded to treatment but 17 continued to excrete the organism in their stools after the course of trimethoprim-sulphamethoxazole compound. Four patients developed rashes during therapy and two became anaemic.     

Antibiotic sensitivity of S. typhi cultures that have reverted from L forms isolated from the blood of patients]

L-forms of bacteria were isolated in 18 out of 300 fever patients with diagnoses of typhoid-paratyphoid fever, grippe, virus respiration disease and others in the Diagnostic Department of an Infection Hospital during bacteriological tests of the blood. Among the cultures tested 13 were instable and reversed to the bacterial form. The type identification showed that only 9 revertants possessed properties characteristic of the typhoid fever microbes and belonged to S. typhi. Sensitivity of the typhoid fever revertants to levomycetin, sintomycin, streptomycin, pencillin and tetracycline was studied. The studies showed that the typhoid fever revertants from the L-forms isolated from the patients were sufficiently sensitive to levomycetin, sintomycin, penicillin and tetracycline. The minimum bactericidal concentrations of the above antibiotics ranged within 12.5--100 gamma/ml.     

莫西沙星治疗78例伤寒的临床疗效观察

目的：探讨莫西沙星在伤寒治疗中的临床意义。方法：将我院2008年6月至2010年6月期间78例确诊的伤寒患者随机分为治疗组（39例）和对照组（39例）,治疗组给予莫西沙星,对照组给予盐酸左氧氟沙星,均静脉滴注,每日1次,体温正常后7d停药。结粜：治疗组痊愈率94．8％,总有效率100％;对照组痊愈率92．3％,总有效率100％,两组痊愈率差异无统计学意义（P〈0．05）;治疗组开始退热和体温降至正常的时间均较对照组缩短,差异有显著意义（P〈0．05）。治疗组不良反应发生率明显低于对照组（P〈0．05）。结论：莫西沙星在伤寒治疗中具有疗效确切、无复发、副作用少等特点,在治疗非耐药和耐药伤寒中有重要作用,有较好的临床应用前景。