Ceftriaxone vs Chloramphenicol for Treatment of Typhoid Fever: Ceftriaxone, a better alternative

Author: Dr. Adil Ramzan

Khyber Medical University, Peshawar, Pakistan

Bannu Medical College, Bannu, Pakistan

Typhoid fever also known as enteric fever is one of the world’s most common diseases. Typhoid fever affects More than 20 million people each year of which 0.7 million people die. In the 1980s the treatment of typhoid fever was started with chloramphenicol, ampicillin and TMP/SMX. But today, most of the bacterial strains that cause typhoid fever are resistant to both ampicillin and TMP/SMX. Resistant strains to chloramphenicol are now emerging. Nowadays third-generation cephalosporin and Floroquinolones are considered first-line agents for the treatment of typhoid fever.
In a study, conducted by Department of Paediatrics and Child Health and Faculty of Medicine of the University of Natal (situated in Durban, Republic of South Africa) compared the efficacy of chloramphenicol and ceftriaxone for the treatment of typhoid fever. They included 59 children in the study. All children were culture positive for Salmonella typhi(causative agent of typhoid fever) and bacterial strains are equally sensitive to both ceftriaxone and chloramphenicol. They were divided into two groups. The ceftriaxone group contained 29 patients and the chloramphenicol group contained 30 patients. Ceftriaxone was given intramuscularly in a dose of 80mg/kg/day for five days and chloramphenicol was given via oral route in a daily dose of 50-100 mg/kg/day in three divided doses for three weeks (21 days). In the ceftriaxone group twenty-three patients became culture negative and free of disease, 2 improved significantly, one failed to improve and two patients relapsed. While in the chloramphenicol group twenty-two patients became disease free, five patients improved significantly, one failed to show any signs of improvement and two patients relapsed. This study concluded that ceftriaxone is a better alternative to treat typhoid fever as compared to conventional chloramphenicol. Because only 5 days of ceftriaxone therapy gives us the same results as those of 21 days long chloramphenicol therapy.
In another study (Treatment of typhoid fever with ceftriaxone for 5 days or chloramphenicol for 14 days, a randomized clinical trial by Aslam, T butler, I Kabir), All patients treated with ceftriaxone became culture negative on third day of treatment while 60 % of those patients who were treated with chloramphenicol were still culture positive. Fever persisted in some patients treated with ceftriaxone for prolong period of time. This study also concluded that 5 days of ceftriaxone therapy is a better alternative to 14 days long chloramphenicol therapy for the treatment of typhoid fever.
Another latest study (2013) that is conducted in Abbassia Fever Hospital, Egypt also declared 5 days treatment course of ceftriaxone as a better alternative to 14-21 days long course of chloramphenicol therapy. According to them, many strains of S. Typhi are now resistant to ampicillin and TMP/SMX. But are still sensitive to chloramphenicol.

Conclusion:

Nowadays, Third generation cephalosporins (eg. Ceftriaxone, Cefotaxime etc) and Fluoroquinolones (eg., Ciprofloxacin) are considered better alternatives to conventional chloramphenicol therapy for the treatment of typhoid fever. The duration of ceftriaxone therapy is significantly lesser than chloramphenicol therapy. The patients become culture negative earlier with ceftriaxone as compared to chloramphenicol. Moreover, resistant strains to chloramphenicol have emerged but resistant strains to ceftriaxone are not yet reported (2013).

References:

1. Ceftriaxone versus Chloramphenicol for Treatment of Acute Typhoid Fever Osama Mohamed Hammad et all. Tropical Medicine Department, Faculty of Medicine, Beni Suef University-Egypt. Tropical Medicine Department, Faculty of Medicine, Cairo University, Egypt.Bacteriology Department, Abbassia Fever Hospital.Former NAMRU, Cairo, Egypt, 2013 Accessed on 22 Aug 2013: https://scholar.cu.edu.eg/?q=medial_sector/files/14_4757life0802_100_105.pdf
2. Treatment of typhoid fever with ceftriaxone for 5 days or chloramphenicol for 14 days: a randomized clinical trial. A Islam, T Butler, I Kabir, and N H Alam. Accessed on 22 aug 2013: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC188021/
3. Once daily ceftriaxone vs. chloramphenicol for treatment of typhoid fever in children.Moosa A, Rubidge CJ. Source: Department of Paediatrics and Child Health, Faculty of Medicine, University of Natal, Durban, Republic of South Africa. Accessed on 22 Aug 2013: https://www.ncbi.nlm.nih.gov/pubmed/2812914