Comparison of Culture Proven Enteric Fever Treatment with Meropenem Alone Vs Combination of Meropenem and Azithromycin
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Abstract
Background: Enteric fever, primarily caused by Salmonella enterica serotypes Typhi and Paratyphi, remains a significant global health challenge, particularly in regions with limited access to clean water and sanitation. The emergence of multidrug-resistant strains has prompted the exploration of effective antibiotic regimens. While Meropenem has become a critical treatment option, the potential benefit of combining it with Azithromycin is not well established.
Objective: The study aimed to compare the efficacy of Meropenem alone versus a combination of Meropenem and Azithromycin in the treatment of culture-proven enteric fever, focusing on fever resolution time and hospital stay duration.
Methods: Conducted at the Combined Military Hospital, Peshawar, this study involved 81 patients diagnosed with enteric fever. They were randomly divided into two groups: Group 1 (n=40) received Meropenem alone, and Group 2 (n=41) received a combination of Meropenem and Azithromycin. Key parameters evaluated included gender distribution, age, duration of defervescence, and length of hospital stay. Statistical significance was assessed using appropriate tests.
Results: The study found no significant difference in the duration of fever resolution (P=0.571) and hospital stay (P=0.466) between the two groups. The mean defervescence time was 5.325 days for Group 1 and 5.4878 days for Group 2. The average hospital stay was 6.4 days for Group 1 and 6.6098 days for Group 2. Gender distribution and age profile were comparable across both groups.
Conclusion: The study concludes that there is no significant difference in the effectiveness of treating enteric fever with Meropenem alone compared to a combination of Meropenem and Azithromycin. This finding supports the use of Meropenem monotherapy as a suitable treatment for enteric fever, potentially reducing treatment protocols and addressing concerns about antibiotic overuse.
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References
Adesegun OA, Adeyemi OO, Ehioghae O, Rabor DF, Binuyo TO, Alafin BA, et al. Current trends in the epidemiology and management of enteric fever in Africa: a literature review. Asian Pacific Journal of Tropical Medicine. 2020;13(5):204-13.
Browne AJ, Kashef Hamadani BH, Kumaran EA, Rao P, Longbottom J, Harriss E, et al. Drug-resistant enteric fever worldwide, 1990 to 2018: a systematic review and meta-analysis. BMC medicine. 2020;18:1-22.
Qamar FN, Hussain W, Qureshi S. Salmonellosis including enteric fever. Pediatric Clinics. 2022;69(1):65-77.
Mburu SN. Antimicrobial Resistance in Non-Typhoidal Salmonella Recovered from Selected Food Animals in Kenya: JKUAT-COHES; 2020.
Marchello CS, Carr SD, Crump JA. A systematic review on antimicrobial resistance among Salmonella Typhi worldwide. The American journal of tropical medicine and hygiene. 2020;103(6):2518.
da Silva KE, Tanmoy AM, Pragasam AK, Iqbal J, Sajib MSI, Mutreja A, et al. The international and intercontinental spread and expansion of antimicrobial-resistant Salmonella Typhi: a genomic epidemiology study. The Lancet Microbe. 2022;3(8):e567-e77.
Sib E, Voigt A, Wilbring G, Schreiber C, Faerber H, Skutlarek D, et al. Antibiotic resistant bacteria and resistance genes in biofilms in clinical wastewater networks. International journal of hygiene and environmental health. 2019;222(4):655-62.
Nabarro L, McCann N, Herdman M, Dugan C, Ladhani S, Patel D, et al. British infection association guidelines for the diagnosis and management of enteric fever in England. Journal of Infection. 2022;84(4):469-89.
Monti G, Bradić N, Marzaroli M, Konkayev A, Fominskiy E, Kotani Y, et al. Continuous vs Intermittent Meropenem Administration in Critically Ill Patients With Sepsis: The MERCY Randomized Clinical Trial. JAMA. 2023.
Heidary M, Ebrahimi Samangani A, Kargari A, Kiani Nejad A, Yashmi I, Motahar M, et al. Mechanism of action, resistance, synergism, and clinical implications of azithromycin. Journal of Clinical Laboratory Analysis. 2022;36(6):e24427.
Al-Marzooq F, Ghazawi A, Daoud L, Tariq S. Boosting the Antibacterial Activity of Azithromycin on Multidrug-Resistant Escherichia coli by Efflux Pump Inhibition Coupled with Outer Membrane Permeabilization Induced by Phenylalanine-Arginine β-Naphthylamide. International Journal of Molecular Sciences. 2023;24(10):8662.
Vanić Ž, Rukavina Z, Manner S, Fallarero A, Uzelac L, Kralj M, et al. Azithromycin-liposomes as a novel approach for localized therapy of cervicovaginal bacterial infections. International Journal of Nanomedicine. 2019:5957-76.
Rahman MM, Alam Tumpa MA, Zehravi M, Sarker MT, Yamin M, Islam MR, et al. An overview of antimicrobial stewardship optimization: the use of antibiotics in humans and animals to prevent resistance. Antibiotics. 2022;11(5):667.
Rabaan AA, Alhumaid S, Mutair AA, Garout M, Abulhamayel Y, Halwani MA, et al. Application of artificial intelligence in combating high antimicrobial resistance rates. Antibiotics. 2022;11(6):784.
Abbott IJ, Peel TN, Cairns KA, Stewardson AJ. Antibiotic management of urinary tract infections in the post-antibiotic era: a narrative review highlighting diagnostic and antimicrobial stewardship. Clinical Microbiology and Infection. 2022.
Vinaik R, Barayan D, Shahrokhi S, Jeschke MG. Management and prevention of drug resistant infections in burn patients. Expert review of anti-infective therapy. 2019;17(8):607-19.
Manyi-Loh C, Mamphweli S, Meyer E, Okoh A. Antibiotic use in agriculture and its consequential resistance in environmental sources: potential public health implications. Molecules. 2018;23(4):795.
Qureshi S, Naveed AB, Yousafzai MT, Ahmad K, Ansari S, Lohana H, et al. Response of extensively drug resistant Salmonella Typhi to treatment with meropenem and azithromycin, in Pakistan. PLoS neglected tropical diseases. 2020;14(10):e0008682.
Blumentrath CG, Müller G, Teichmann D, Tiesmeier J, Petridou J. Relapse of typhoid fever following delayed response to meropenem: a case report and review of previously published cases indicating limited clinical efficacy of meropenem for the treatment of typhoid fever. GMS German Medical Science. 2019;17.
Zmora N, Shrestha S, Neuberger A, Paran Y, Tamrakar R, Shrestha A, et al. Open label comparative trial of mono versus dual antibiotic therapy for Typhoid Fever in adults. PLoS Neglected Tropical Diseases. 2018;12(4):e0006380.
Parry CM, Qamar FN, Rijal S, McCann N, Baker S, Basnyat B, editors. What Should We Be Recommending for the Treatment of Enteric Fever? Open Forum Infectious Diseases; 2023: Oxford University Press US.
Giri A, Karkey A, Dongol S, Arjyal A, Maharjan A, Veeraraghavan B, et al. Azithromycin and cefixime combination versus azithromycin alone for the out-patient treatment of clinically suspected or confirmed uncomplicated typhoid fever in South Asia: a randomised controlled trial protocol. Wellcome Open Research. 2021;6.
Hussain I, Faisal MS, Khan A, Jamal A, Hayat W. CLINICAL EFFECTIVENESS OF AZITHROMYCIN VERSUS CIPROFLOXACIN IN THE TREATMENT OF UNCOMPLICATED ENTERIC FEVER IN CHILDREN. Journal of Medical Sciences. 2020;28(4):372-6.
Kuehn R, Stoesser N, Eyre D, Darton TC, Basnyat B, Parry CM. Treatment of enteric fever (typhoid and paratyphoid fever) with cephalosporins. Cochrane Database of Systematic Reviews. 2022(11).
Dahiya S, Malik R, Sharma P, Sashi A, Lodha R, Kabra SK, et al. Current antibiotic use in the treatment of enteric fever in children. The Indian Journal of Medical Research. 2019;149(2):263.
Hagmann SH, Angelo KM, Huits R, Plewes K, Eperon G, Grobusch MP, et al. Epidemiological and clinical characteristics of international travelers with enteric fever and antibiotic resistance profiles of their isolates: a GeoSentinel analysis. Antimicrobial agents and chemotherapy. 2020;64(11):10.1128/aac. 01084-20.
Hijazi K, Joshi C, Gould IM. Challenges and opportunities for antimicrobial stewardship in resource-rich and resource-limited countries. Expert Review of Anti-infective Therapy. 2019;17(8):621-34.
Raymond B. Five rules for resistance management in the antibiotic apocalypse, a road map for integrated microbial management. Evolutionary applications. 2019;12(6):1079-91.