The Use of Azithromycin in Pediatric Typhoid Fever without Complication: A Case Report
DOI:
https://doi.org/10.33096/gmj.v6i1.123Keywords:
Typhoid fever, salmonella typhi, enteric fever, azithromycinAbstract
Typhoid fever is an infection caused by the bacterium Salmonella typhi. The prevalence is still high among emerging countries, such as Indonesia. There are limited options for the treatment of typhoid fever in children and more so is complicated by the emergence of antimicrobial resistance. The use of azithromycin has evolved as an important drug in the treatment of typhoid.
A male, aged 7 years and 2 months, was admitted to our hospital with remittent fever 4 days prior. The patient also presented with a period of cough since 2 days, and constipation, with full consciousness. The child had basic immunization completed for his age. He had a history of frequent consumption of street food. The diagnosis of typhoid fever was confirmed by serologic testing of positive 8 IgM Salmonella. Initially, the patient was treated with intravenous antibiotics of ceftriaxone for 8 days but shoed no clinical improvement, then the treatment was changed to intravenous azithromycin for 4 days and his condition improved greatly. The patient showed a better response with the use of azithromycin.
The management of typhoid fever remains challenging up to this day with variations in treatment response. From this case, we can conclude that azithromycin in some patients may show better improvement in the management of typhoid fever in pediatric patients. Although, ceftriaxone and other third-generation cephalosporins are still highly effective against Salmonella typhi.
References
Kadir S, et al. Salmonella Hepatitis in Children: A Update. Dhaka, Pakistan: Northern International Medical College Journal. 2019.
Ahmad S. Assessment of Liver Function Tests in Children with Typhoid Fever: A Hospital Based Study. Nepal: Journal of Nepal Medical College. 2019
Parry MC, Hien TT, Dougan G et al.Typhoid Fever. The new England journal of medicine. 2002: 347(22); 1770-82.
Rao KN, Pratusha R, Acharya A. Azithromycin and ceftriaxone in uncomplicated typhoid fever in paediatric patients: a prospective comparative and randomized open labelled trail. Int J Contemp Pediatr 2020;7:2316-20
Effa EE and Bukirwa H. Azithromycin for treating uncomplicated typhoid and paratyphoid fever (enteric fever). The Cochrane library. 2008. 1-38
Abramowics M, Zuccoti G, editors: Handbook of antimicrobial drugs: drugs for bacterial infections. The Medical Letter, ed 20, New Rochelle, NY 2015.
Hadinegoro, Sri Rezeki, et al. Demam Tifoid dalam Buku Ajar Infeksi dan Penyakit Tropis edisi Keempat. Jakarta: Badan Penerbit Ikatan Dokter Anak Indonesia. 2016.
Kliegman, Robert, et al. Typhoid Fever in Children. Philadelphia. 2016: Nelson Textbook of Pediatrics 20th Editiom.
Suwatro S, et al. Laboratory Parameters for Predicting Salmonella Bacteremia: a Prospective Cohort Study. Jakarta, Indonesia: SAGE pub journal. 2016
Karoli R, Fatima J, Chandara A, Singh G. Salmonella hepatitis: An uncommon complication of a common disease. J Fam Med Primary Care 2012;1:160-2.
Zmora N, Shrestha S, Neuberger A, Paran Y, Tamrakar R, Shrestha A, et al. (2018) Open label comparative trial of mono versus dual antibiotic therapy for Typhoid Fever in adults. PLoS Negl Trop Dis 12(4): e0006380. https://doi/org/10.1371/journal.pntd.0006380
Sumit Raim Umesh Shukla, Arti Kapil, Suhsila Dahiya, Priyanka Sharma, Cefriaxone treatment failure in two cases of Enteric Fever caused by CTX-M15 positive Salmonella Typhi and its gastrointestinal carriage, Indian Journal of Medical Microbiology, 2022, https://doi.org/10.1016/j.ijmmb.2022.04.001
Craig WA, Andes DR. In vivo activities of ceftazolone, a new cephalosporin, with and without tazobactam against Pseudomonas aeruginosa and Enterbacteriaceae, including strains with extended spectrum B-lactamses, in the thighs of neutropenic mice. Antimicrob Agents Chemother. 2013;57:1577-1582.
Antolis Y, Rampengan T, Wilar R, Homenta Rampengan N. Azithromycin vs. chloramphenicol for uncomplicated typhoid fever in children. Vol. 53, Original Artice Paediatr Indones.
Ullah I, Khan K, Mehmood Q, Malik M, Ahmed A, Munir U. Irrational use of azithromycin in typhoid endemic areas: A challenge on multidrug-resistant typhoid treatment. Vol. 1, Review Article, Trends in Infection and Global Health 2021
