Cefixime in the treatment of uncomplicated multi-drug resistant Salmonella typhi septicaemia in children

Abstract

The common occurrence of Salmonella typhi resistant to most antibiotics typically used for treatment of typhoid fever has limited therapeutic options for infections caused by this organism especially in children due to the restriction of the use of quinolones. Initially, we conducted a randomized open label study testing the efficacy of Cefixime to Ceftriaxone or Aztreonam in the treatment of uncomplicated typhoid fever in children. Of the 165 enrolled with clinical typhoid fever, 124 were culture positive for S. typhi, fifty children were treated with Cefixime (7.5 mg/kg/dose orally twice daily for 15 days), 43 children with ceftriaxone (50-70 mg/Kg/dose given intramuscularly IM once daily for 5 days) and 31 with Aztreonam (50-70 mg/kg/dose every 8 hours JM for 7 days). There were no clinical or microbiological failures in any of the groups. However, there was an 5%-6% relapse rate in each of the treatment groups. In a subsequent open trial, Cefixime (20 mg/kg/dose given orally once daily for 8 days) was administered to 60 children 3-16 years with culture proven multi-drug resistant S. typhi. 95% (57/60) of the children had clinical and microbiological cure and only 1 patient had a relapse within 4 weeks after completion of therapy. Cefixime was well tolerated by all children. These studies indicate that cefixime is an effective alternative for the treatment of typhoid fever in children.