Treatment of typhoid fever with azithromycin versus chloramphenicol in a randomized multicentre trial in India

To compare the clinical and bacteriological efficacies of azithromycin and chloramphenicol for treatment of typhoid fever, 77 bacteriologically evalua ble adults, with blood cultures positive for Salmonella typhi or Salmonella paratyphi A susceptible to their assigned drugs, were entered into a rando mized open trial at four hospitals in India. Forty-two patients were random ized to receive azithromycin 500 mg po od for 7 days and 35 to receive chlo ramphenicol 2-3 g po od in four divided doses for 14 days. Thirty-seven pat ients (88%) in the azithromycin group responded with clinical cure or impro vement within 8 days and 30 patients (86%) in the chloramphenicol group res ponded with cure or improvement. By day 14 after the start of treatment, al l patients treated with azithromycin and all except two of the patients tre ated with chloramphenicoi (94%) were cured or improved. Blood cultures repe ated on day 8 after start of therapy showed eradication of organisms in 100 % of patients in the azithromycin group and 94% of patients in the chloramp henicol group. By day 14 the eradication rate in the chloramphenicol group had increased to 97%. Stool cultures on days 21 and 35 after start of treat ment showed no prolonged faecal carriage of Salmonella spp. in either group . These results indicate that azithromycin given once daily for 7 days was effective therapy for typhoid fever in a region endemic with chloramphenico l-resistant S. typhi infection and was equivalent in effectiveness to chlor amphenicol given to patients with chloramphenicol-susceptible infections.