TREATMENT OF TYPHOID-FEVER WITH CEFTRIAXONE FOR 5 DAYS OR CHLORAMPHENICOL FOR 14 DAYS - A RANDOMIZED CLINICAL-TRIAL

To compare the therapeutic efficacy of ceftriaxone given once daily fo r 5 days and chloramphenicol given four times daily for 14 days, a con trolled trial was carried out with 59 patients who were culture positi ve for Salmonella typhi. Ceftriaxone was given to 28 patients in once- daily intravenous doses of 75 mg/kg of body weight to children and 4 g to adults for 5 days; chloramphenicol was given to 31 patients at a d osage of 60 mg/kg/day until defervescence and then at 40 mg/kg/day to complete 14 days of treatment. All Salmonella isolates were susceptibl e to both antibiotics. Clinical cures (defervescence without complicat ions, no relapse, and no need for further treatment) occurred in 79% o f the patients treated with ceftriaxone and 90% of those treated with chloramphenicol (P = 0.37). On the third day of treatment, blood cultu res were positive for S. typhi for 60% of the patients in the chloramp henicol group and 0% of the ceftriaxone group (P = 0.001). Defervescen ce occurred in half the patients in both groups during the first 7 day s, but on days 9 to 13 after the start of treatment, nine patients in the ceftriaxone group, compared with six patients in the chloramphenic ol group, remained febrile (P = 0.4). The median hematocrit and total leukocyte counts at day 14 were significantly lower for the chloramphe nicol group than those for the ceftriaxone group (P = 0.01 and P = 0.0 2, respectively). These results indicate that the effects of therapy w ith ceftriaxone for typhoid fever differed from those of chloramphenic ol therapy in that blood cultures became negative earlier, prolonged f ever persisted in some patients, and bone marrow suppression was reduc ed. We conclude that a short, 5-day course of ceftriaxone is a useful alternative to conventional 14-day chloramphenicol therapy in the trea tment of typhoid fever.