Azithromycin versus ciprofloxacin for treatment of uncomplicated typhoid fever in a randomized trial in Egypt that included patients with multidrug resistance

To compare clinical and bacteriological efficacies of azithromycin and cipr ofloxacin for typhoid fever, 123 adults with fever and signs of uncomplicat ed typhoid fever were entered into a randomized trial. Cultures of blood we re positive for Salmonella typhi in 59 patients and for S. paratyphi A in 3 cases; stool cultures were positive for S. typhi in 11 cases and for S, pa ratyphi A in 1 case. Multiple-drug resistance (MDR; resistance to ampicilli n, chloramphenicol, and trimethoprim-sulfamethosazole) was present in isola tes of 21 of 64 patients with positive cultures. Of these 64 patients, 36 r eceived 1 g of azithromycin orally once on the first day, followed by 500 m g given orally once daily on the next 6 days; 28 patients received 500 mg o f ciprofloxacin orally twice daily for 7 days. Blood cultures were repeated on days 4 and 10 after the start of therapy, and stool cultures were done on days 4, 10, and 28 after the start of therapy. All patients in both grou ps improved during therapy and were cured. Defervescence (maximum daily tem peratures of less than or equal to 38 degrees C) occurred at the following times [mean +/- standard deviation (range)] after the start of therapy: 3.8 +/- 1.1 (2 to 7) days with azithromycin and 3.3 +/- 1.0 (1 to 5) days with ciprofloxacin, No relapses were detected. Cultures of blood and stool duri ng and after therapy were negative in all cases, except for one patient tre ated with azithromycin who had a positive blood culture on day 4, These res ults indicated that azithromycin and ciprofloxacin were similarly effective , both clinically and bacteriologically, against typhoid fever caused by bo th sensitive organisms and MDR S. typhi.