Comparative efficacy and safety of azithromycin monotherapy and azithromycin+cefixime combination therapy in uncomplicated typhoid fever

Manish Chandey, Ranjeet Kaur, Gurinder Mohan, Rahul Mannan, Kapila Mahajan


Background: Typhoid fever continues to occur on a large scale in countries where sanitation is suboptimal. For the last few years quinolones resistant strains of salmonella typhi are being reported. Now the third generation cephalosporins are being used as first line agent for typhoid fever .Since last few years various oral drug combinations have been tried and are available in Indian market for the treatment of typhoid fever. The present study was designed to evaluate the clinical efficacy, side effects and relapse rate of azithromycin monotherapy in uncomplicated typhoid fever cases as compared to those who were treated with azithromycin and cefixime combination therapy in standard dosage.

Methods: 100 adult proven cases of typhoid fever of the age group of 16-65 years of either sex were included in the study. These patients were randomly divided into 2 groups of 50 patients each and then were followed up on and after treatment for 4 weeks. Group I: Patients were given oral azithromycin 500 mg twice daily for 7days. Group II: Patients were given oral Azithromycin 500 mg twice daily with oral cefixime 200 mg twice daily for 7 days.

Results: No statistically significant difference was found in fever clearance time in two study groups.  So both study groups were found comparable in terms of mean fever clearance time and clinical cure.

Conclusions: Both mono and combination therapy could be equally effective oral therapy for typhoid fever. More studies have to be conducted in our scenario to reach a conclusion.


Azithromycin combination therapy, Typhoid fever

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WHO. The global burden of typhoid fever. Bull World health Organization, 2004;82(5):346-53.

Erslev A, Wintrobe MM. Detection and Prevention of Drug induced Blood dyscrasias. J Amer Med Assoc. 1962;181:114-9.

Dastur FD. Salmonellosis – in API Text Book of Medicine, 6th edn. 1999: 37-40.

Butt T, Rifat NA, Abid M, Zaidi S. Ciprofloxacin treatment failure in typhoid fever cases, Pakistan. Emerg Infec Dis. 2003;9(12):1621-2.

Joshi S, Amarnath SK. Fluoroquinolone resistance in Salmonella typhi and S. paratyphi A in Bangalore, India. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2007;101(3):308-10.

Butler T, Sridhar CB, Daga MK, Pathak K, Pandit RB, Khakhria R et al. Treatment of typhoid fever with Azithromycin versus chloramphenicol in a randomized multicentre trial in India. J Antimicrob chemother. 1999;44(2):243-50.

Girgis NI, Butler T, Frenck RW, Sultan Y, Brown FM, Tribble D. Azithromycin versus ciprofloxacin for treatment of uncomplicated typhoid fever in a randomized trial that included patients with multidrug resistance. Antimicrob Agents Chemother. 1999;43(6):1441-4.

Chinh NT, Parry CM, Ly NT, Ha HD, Thong MX, Diep TS et al. A randomized controlled comparison of Azithromycin and ofloxacin for treatment of multidrug-resistant or nalidixic acid-resistant enteric fever. Antimicrob Agents Chemother. 2000;44(7): 1855-9.

Chau TT, Campbell JI, Galindo CM, Van Minh Hoang N, Diep TS, et al. Antimicrobial drug resistance of Salmonella enterica serovar typhi in Asia and molecular mechanism of reduced susceptibility to the fluoroquinolones. Antimicrob Agents Chemother. 2007;51:4315-23.