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Letters to the Editor

Indian Pediatrics 2000;37: 222

Ceftibuten in Enteric Fever

We evaluated four drugs, namely, Cipro-floxacin, Cefatoxime, Ceftriaxone and Cefti-buten on 42 cases of typhoid fever. The diag-nosis of typhoid fever was made on the basis of clinical profile supported by either a positive blood culture for S. typhi or positive Widal agglutination titre of `O' and `H' of minimum 160 or four fold rise.

Specific therapy with a particular drug was started on the basis of blood culture and sensitivity report. If the basis of diagnosis was clinical profile and significant Widal titer with negative blood culture, then any of the four drugs evaluated in the study was started in a random manner. Doses employed in the study were: (i) Suspension Ceftibuten 9 mg/kg PO-single dose; (ii) Injection Ceftriaxone 75 mg/kg/day; (iii) Injection Cefatoxime 150 mg/kg/day and (iv) Tablet Ciprofloxacin 20 mg/kg/day.

Subjective improvement of the child and an afebrile period of continuous three days was considered as response to the drug. If the criteria of three consecutive days of afebrile period was met with then the first day of defervescence was taken as `day of response'. Of the 42 diagnosed cases of enteric fever which were studied 18 (42%) had grown organisms in the blood culture while the remaining were Widal positive with clinical profile suggestive of typhoid fever. Age of the patients ranged from 2-10 years. Sensitivity to Ceftibuten and Ceftriaxone was 100% (18 cases each) whereas sensitivity was 80% (14 cases) and 40% (7 cases), respectively for Cefatoxime and Ciprofloxacin.

Of the total 42 cases, Ceftibuten resulted, (n=18) in a response in 3-5 days (mean = 4 days); Ceftriaxone (n= 9) in 4-7 days (mean 5.8 days), Cefatoxime (n=11) in 4-7 days (mean 6.4 days), and Ciprofloxacin (n=4) in 7-10 days (mean 8.3 days). Ceftibuten was used in 12 children, on random basis, before the culture results were available. Six children were administered Ceftibuten after an unsuccessful trial of 6 days with any of the three other drugs. All 42 children recovered fully and there were no relapses on follow up of one month. No adverse affects, either, clinical (gastrointestinal, serum sickness, convulsion) or hematological (leukopenia, eosinophilia) were noted in any of the patients. Transaminase levels remained within normal range all through the duration of treatment with Ceftibuten.

We found 100% sensitivity to Ceftibuten and Ceftriaxone in our study. The mean day of defervescence was earliest for Ceftibuten (4 days) and longest for Ciprofloxacin (8.3 days). With feasibility of oral administration and single or two divided doses schedule, compliance with Ceftibuten is likely to be good. Unlike Ceftri-axone, no hospitalization is required for administering cetibuten which could thus have a role in resistant enteric fever. Ours, however, is a small study with its intrinsic handicaps. In order to draw definite conclusions a randomized controlled study with a larger sample size is recommended.

A.K. Dubey,
C. Vidyashankar,
S.S. Bhata,
R.K. Sharma,

Department of Pediatrics, Base Hospital,
Delhi Cantonment, Delhi 110 010, India.
E-mail : vidyashankar@vsnl.com

References

1. Bhatnagar S, Chandra J. Ceftibuten. Indian Pediatr 1999; 36: 901-904.

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