COMPARISON OF THE EFFICACY, SAFETY AND COST OF CEFIXIME, CEFTRIAXONE AND AZTREONAM IN THE TREATMENT OF MULTIDRUG-RESISTANT SALMONELLA-TYPHISEPTICEMIA IN CHILDREN

An increase in the incidence of Salmonella typhi strains resistant to chloramphenicol, ampicillin and trimethoprim-sulfamethoxazole causing enteric fever in Egyptian children stimulated the evaluation of altern ative drugs. Children with positive blood cultures were treated with c efixime, ceftriaxone or aztreonam, and the efficacy, safety and cost o f these regimens were evaluated and compared. Cefixime (7.5 mg/kg) was given orally twice daily to 50 children for 14 days, ceftriaxone (50 to 70 mg/kg) was given im once daily for 5 days to 43 children and azt reonam (50 to 70 mg/kg) was given im every 8 hours for 7 days to 31 ch ildren. Children in the 3 groups were comparable with regard to age, s ex, duration and severity of illness before admission. All children we re cured. A significant difference (P < 0.05) in duration of treatment before becoming afebrile seemed to favor ceftriaxone (3.9 days) over aztreonam (5.5 days) and cefixime (5.3 days), During the 4-week follow -up period relapses occurred in 3 (6%) children in the cefixime group, in 2 (5%) in the ceftriaxone group and in 2 (6%) in the aztreonam gro up. Safety and efficacy were comparable for all 3 drugs. Ceftriaxone w as most cost-effective on an inpatient basis, because of a more rapid clinical cure, and cefixime was the most cost-effective on an outpatie nt basis, because of drug cost.