Background: Typhoid fever, also known as enteric fever, is a severe systemic illness characterized by fever and gastrointestinal manifestations that commonly affects children and young adults. It is most prevalent in SouthCentral Asia, Southern Africa, and Southeast Asia. Alternative drugs for the treatment of enteric fever have been studied to decrease toxicity and increase compliance. Oral azithromycin has been proposed and is widely studied as a suitable treatment alternative. Objective: The objective of this study is to compare oral azithromycin with intravenous ceftriaxone in the treatment of uncomplicated typhoid fever in terms of cure, duration of fever, relapse, and adverse events. Methodology: A systematic review and meta-analysis were done with eligible studies taken from PUBMED, MEDLINE, and Cochrane Clinical Trial Registry. Six studies passed the eligibility criteria and were analyzed using Review Manager 5.3. Results: Azithromycin showed comparable results with ceftriaxone in terms of cure, duration of fever and adverse events. However, azithromycin proved superior in decreasing relapse. Conclusion: Azithromycin is comparable to ceftriaxone in the treatment of uncomplicated typhoid fever in terms of cure, duration of fever, and occurrence of adverse events. Azithromycin likewise had a lower incidence of relapse. Recommendations We recommend conducting local trials in pediatric patients, to compare azithromycin with standard antibiotic regimen for typhoid fever, to help update local recommendations and expand choices for antibiotic use.
Typhoid Fever ; Azithromycin ; Ceftriaxone

Ceftriaxone is known to induce a precipitation in the gallbladder that mimics gallstones on sonography in the children and adults. "Biliary pseudolithiasis" is now used to describe this reversible, benign complication accompanying ceftriaxone therapy. It is important to be aware of this adverse effect because it does not need any specific treatment. To our knowledge, there have not been any reports of CT findings of ceftriaxone-associated biliary pseudolithiasis in literature. We herein report two cases of ceftriaxone-associated biliary pseudolithiasis with sonographic and CT findings, which were completely resolved after the cessation of ceftriaxone therapy.
Adult ; Ceftriaxone ; Child ; Gallbladder ; Gallstones ; Humans ; Ultrasonography*

The burden of typhoid fever remains high in impoverished settings, and increasing antibiotic resistance is making treatment costly. The purposes of this study were: to compare the costs and the effectiveness of typhoid programs between oral and injection treatments in pediatric patients at Songkhla Hospital. This study was an incidence-based cost-of-illness analysis from providers’ perspective. Micro-costing approach was employed for calculating patient-specific data. The study was conducted in Songkhla Hospital in the southern part of Thailand from 2009 to 2010. The total number of the cases was 78. Patients taking antibiotics for 48 hours, and those suspected of having complicated typhoid fever like peritonitis, ileus, toxic encephalopathy were excluded. We collected and reviewed medical records. In all provisionally selected children, blood was drawn for complete blood count, widal test and blood culture. The statistics used in data analysis were descriptive statistics and the cost-effectiveness of typhoid treatment with the two methods was compared using independent t-test. The results of the study revealed that the average cost of typhoid treatment with oral Ciprofloxacin calculated with DRG was 3,301.88 baht which was lower than that of injection Ceftriaxone treatment calculated with DRG (3,615.05 baht). When the operation costs were considered, the results of the study remained the same, i.e. the treatment cost of typhoid with oral Ciprofloxacin was two times lower than that with injection Ceftriaxone. The average cost of the oral treatment was 2,844.45 baht, and that of the injection treatment was 5,303.19 baht. Regarding the effectiveness of typhoid treatment with Ciprofloxacin measured from the time the fever was reduced, it was found that the body temperature of the two methods of treatment were used was not significantly different (p<.05). The patients on oral medications had a fever for an average of 3.36 days while those on injection treatment had a fever for an average of 3.76 days. However, the lengths of stay (LOS) of the two groups of patients were significantly different. The results of this study showed that the cost-effectiveness of oral treatment was better than injection. Bedside, the patient and caregiver spent less time when oral treatment was administered than when injection treatment was used. Therefore, the direct cost for treatment was reduced and the indirect cost as a result from LOS was also reduced. Above all, the patient did not get pain from injection while the effectiveness of fever reduction was not different.
Costs and Cost Analysis ; Ciprofloxacin ; Ceftriaxone ; Typhoid Fever ; Child ; Thailand

Objectives: The incidence of multidrug resistant enteric fever is increasing alarmingly. This study was planned to determine the rate of isolation of Salmonella spp. and to compare the isolates for their epidemiological parameters and antimicrobial susceptibility patterns at our center. Methods: The study was conducted over a span of three years with a total of 8142, 8134, and 8114 blood culture samples processed for the years 2008, 2009, and 2010 respectively. The minimum inhibitory concentration (MIC) for ciprofloxacin and chloramphenicol was determined using an agar dilution method. The MIC for ciprofloxacin was also confirmed by Epsilon-test (E -test) strips. Results: Of the total 302 Salmonella spp. isolated, 257 were Salmonella enterica serotype Typhi (85.1%) and 45 (14.9%) were S. enterica serotype Paratyphi A. The majority of the isolates recovered were from the pediatric age group (54.6%) and males (60.6%). Complete susceptibility was observed to chloramphenicol, cefotaxime, ceftriaxone, and azithromycin over the last two years (2009 and 2010), with an increase in resistance to nalidixic acid (100%) and ciprofloxacin (13.6%). Conclusions: In our study, we found augmentation of resistance to nalidixic acid and fluoroquinolones and complete sensitivity to ceftriaxone along with reemergence of chloramphenicol sensitivity for Salmonella isolates. This report emphasises the necessity of continuous surveillance of antibiograms of enteric fever isolates in an area.
Drug Resistance, Microbial ; Ceftriaxone ; Ciprofloxacin ; Typhoid Fever ; Salmonella

BACKGROUND: During the era of increasing penicillin resistant Streptococcus pneumoniae, it is important to have knowledge about adequate dosage and dosing interval of ceftriaxone (CTR). We examined efficacies of once-daily CTR and compared results in an in vitro pharmacodynamic infection model (IVPDIM) supplemented with albumin and those without albumin. METHODS: Using three clinically isolated S. pneumoniae that were susceptible (SM24), intermediate (SM47) and resistant (SM60) against CTR, we utilized a two-compartment IVPDIM. CTR 2 g was administered intravenously every 24 h. Human albumin was added with concentration of 4 g/dL. Samples were removed at multiple time points over a 48-h period to determine the colony counts. RESULTS: In SM24 and SM60, bactericidal effects were observed within 6 hours in groups without albumin. The number of colonies during 1st 6 hours were more decreased in albumin-free groups than in albumin-supplemented groups (P<0.05). In SM47, similar results were found during 1st 6 hours (P=0.03). But, regrowth was observed in albumin supplemented group at 30 h. Irrespective of results of minimal inhibitory concentrations and albumin supplementation, bactericidal effects were shown at 24 h in all 3 strains. All groups were decreased below the detection limit at 48 h. Development of resistance was not detected throughout the entire study period in either strain. CONCLUSIONS: Although extents of killing in albumin supplemented broth of once-daily CTR dosing were delayed in all 3 strains compared with those of albumin free broth, final efficacies were not different between the two groups.
Ceftriaxone* ; Homicide ; Humans ; Limit of Detection ; Penicillins ; Pneumonia ; Streptococcus pneumoniae* ; Streptococcus*

BACKGROUND: Ertapenem, a novel beta-lactam agent with a wide range of activity, has a pharmacokinetic profile and antimicrobial spectrum that support its potential use as a once-a-day agent for the treatment of common mixed aerobic and anaerobic pathogens encountered in intraabdominal infections. MATERIALS AND METHODS: The prospective, randomized, controlled, open, and multicenter trial was conducted to compare the clinical efficacy and safety of ertapenem with ceftriaxone plus metronidazole as therapy before or following adequate surgical management of complicated intraabdominal infections. RESULTS: One hundred sixty-three patients were included in the modified intent-to-treat population, of which 134 were clinically evaluable. Patients with a wide range of infections were enrolled; perforated appendicitis or periappendiceal abscess were most common. As for the modified intent-to-treat groups, 71 of 72 (98.6%) patients treated with ertapenem and 73 of 80 (91.3%) treated with ceftriaxone/metronidazole showed favorable clinical response. CONCLUSION: In this study, the efficacy of ertapenem was equivalent to ceftriaxone plus metronidazole in the treatment of complicated intraabdominal infections. Ertapenem was generally well tolerated and had a similar safety and tolerability profile compared to ceftriaxone plus metronidazole. The results of this trial suggest that ertapenem could be considered as a useful option that could eliminate the need for combination and/or multi-dosed antibiotic regimens for the empiric treatment of complicated intraabdominal infections.
Abscess ; Adult* ; Appendicitis ; Ceftriaxone* ; Humans ; Intraabdominal Infections* ; Metronidazole* ; Prospective Studies

BACKGROUND: During the era of increasing penicillin resistant Streptococcus pneumoniae, it is important to have knowledge about adequate dosage and dosing interval of ceftriaxone (CTR). We examined efficacies of once-daily CTR and compared results in an in vitro pharmacodynamic infection model (IVPDIM) supplemented with albumin and those without albumin. METHODS: Using three clinically isolated S. pneumoniae that were susceptible (SM24), intermediate (SM47) and resistant (SM60) against CTR, we utilized a two-compartment IVPDIM. CTR 2 g was administered intravenously every 24 h. Human albumin was added with concentration of 4 g/dL. Samples were removed at multiple time points over a 48-h period to determine the colony counts. RESULTS: In SM24 and SM60, bactericidal effects were observed within 6 hours in groups without albumin. The number of colonies during 1st 6 hours were more decreased in albumin-free groups than in albumin-supplemented groups (P<0.05). In SM47, similar results were found during 1st 6 hours (P=0.03). But, regrowth was observed in albumin supplemented group at 30 h. Irrespective of results of minimal inhibitory concentrations and albumin supplementation, bactericidal effects were shown at 24 h in all 3 strains. All groups were decreased below the detection limit at 48 h. Development of resistance was not detected throughout the entire study period in either strain. CONCLUSIONS: Although extents of killing in albumin supplemented broth of once-daily CTR dosing were delayed in all 3 strains compared with those of albumin free broth, final efficacies were not different between the two groups.
Ceftriaxone* ; Homicide ; Humans ; Limit of Detection ; Penicillins ; Pneumonia ; Streptococcus pneumoniae* ; Streptococcus*

BACKGROUND: Ertapenem, a novel beta-lactam agent with a wide range of activity, has a pharmacokinetic profile and antimicrobial spectrum that support its potential use as a once-a-day agent for the treatment of common mixed aerobic and anaerobic pathogens encountered in intraabdominal infections. MATERIALS AND METHODS: The prospective, randomized, controlled, open, and multicenter trial was conducted to compare the clinical efficacy and safety of ertapenem with ceftriaxone plus metronidazole as therapy before or following adequate surgical management of complicated intraabdominal infections. RESULTS: One hundred sixty-three patients were included in the modified intent-to-treat population, of which 134 were clinically evaluable. Patients with a wide range of infections were enrolled; perforated appendicitis or periappendiceal abscess were most common. As for the modified intent-to-treat groups, 71 of 72 (98.6%) patients treated with ertapenem and 73 of 80 (91.3%) treated with ceftriaxone/metronidazole showed favorable clinical response. CONCLUSION: In this study, the efficacy of ertapenem was equivalent to ceftriaxone plus metronidazole in the treatment of complicated intraabdominal infections. Ertapenem was generally well tolerated and had a similar safety and tolerability profile compared to ceftriaxone plus metronidazole. The results of this trial suggest that ertapenem could be considered as a useful option that could eliminate the need for combination and/or multi-dosed antibiotic regimens for the empiric treatment of complicated intraabdominal infections.
Abscess ; Adult* ; Appendicitis ; Ceftriaxone* ; Humans ; Intraabdominal Infections* ; Metronidazole* ; Prospective Studies

Ceftriaxone, a potent third-generation semisynthetic cephalosporine, is widely used for treatment various bacterial infections in children. There have been some reports that transient appearance of gallbladder sludge was often demonstrated by abdominal sonography in patients treated with ceftriaxone. Reversible biliary pseudolithiasis was used to describe this phenomenon. We present a case of biliary pseudolithiasis which appeared to be related to intravenous ceftriaxone therapy in children who received ceftriaxone to treat meningitis. The recommended ceftriaxone dose was 100mg/kg/day and a total duration of administrations was 21 days. Abdominal sonographic examination showed nothing prior to antibiotic therapy, however, multiple tiny hyperechogenic materials were observed in gallbladder on day 7 of treatment. This patient did not demonstrate any symptoms. Follow-up abdominal sonography examination revealed that gallbladder materials began to resolve spontaneously on third day of posttherapy and complete resolution was observed on day 13 after cessation of ceftriaxone therapy.
Bacterial Infections ; Ceftriaxone* ; Child ; Follow-Up Studies ; Gallbladder ; Humans ; Meningitis ; Sewage ; Ultrasonography

Ceftriaxone is a commonly used antibiotic due to some of its advantages. Reversible gallbladder (GB) sludge or stone has been reported after ceftriaxone therapy. Most of these patients have no symptom, but the GB sludge or stone can sometimes cause cholecystitis. We experienced two patients who had newly developed GB stones after ceftriaxone therapy for diverticulitis and pneumonia, and this resolved spontaneously 1 month after discontinuation of the drug. Awareness of this complication could help to prevent unnecessary cholecystectomy.
Ceftriaxone ; Cholecystectomy ; Cholecystitis ; Cholecystolithiasis ; Diverticulitis ; Gallbladder ; Gallstones ; Humans ; Pneumonia ; Sewage ; Young Adult