CIPROFLOXACIN VERSUS CEFTRIAXONE IN THE TREATMENT OF MULTIRESISTANT TYPHOID-FEVER

A randomized trial comparing ceftriaxone (3 g given parenterally per d ay for 7 days) to ciprofloxacin (500 mg given orally twice a day for 7 days) in the treatment of blood culture positive typhoid fever was co nducted. Twenty patients were openly randomized to receive ciprofloxac in and 22 to receive ceftriaxone. The outcome was classified as clinic al failure in 6 patients (27 %) in the ceftriaxone group, but in none in the ciprofloxacin group (p = 0.01). The mean duration of fever was four days in the ciprofloxacin group and about five days in the ceftri axone group (p = 0.04). In the six patients in the ceftriaxone group w ho experienced failure, therapy was switched to ciprofloxacin and the patients became afebrile and asymptomatic within 48 hours. Patients wi th resistant strains of Salmonella typhi and patients with sensitive s trains responded equally well to ciprofloxacin therapy. Analysis of a subset of 12 of the multiresistant strains revealed that resistance wa s encoded for by a transferable 180 kilobase plasmid. Ciprofloxacin re presents a useful treatment option in areas where multiresistant strai ns are likely to be encountered.