Azithromycin for treating uncomplicated typhoid and paratyphoid fever (enteric fever).
Typhoid or paratyphoid fevers (known as enteric fever) are infectious diseases caused by Salmonella bacteria. There were over 25 million new cases worldwide in 2000. Infections are mostly in the middle- and low-income countries where sanitation and water supplies are poor. The diseases are common in the Indian subcontinent, South-East and Far East Asia, Africa, Central and South America, and the Mediterranean region. Enteric fever occurs mainly in young people between five and 19 years and in some areas it is common among children less than five years' old. The infection is usually transmitted by ingestion of food or water contaminated with faeces from people who have the infection. Symptoms include intermittent fever, severe headaches, abdominal discomfort, loss of appetite, malaise, vague abdominal tenderness, and enlarged liver and/or spleen. About 10% to 15% of people get complications, which include bleeding, shock, and inflammation of the pancreas, heart muscles, and the brain. For many years, antibiotics such as chloramphenicol, ampicillin, and cotrimoxazole were used for treating enteric fever. However, multiple-drug resistant strains of the bacteria have now emerged. Other antibiotics like the fluoroquinolones, cephalosporins, and azithromycin are used as well. This review of trials looked at azithromycin as a treatment for uncomplicated enteric fever. There were seven trials (from Egypt, Vietman, and India) involving 773 people, all treated in hospital. There was limited evidence showing azithromycin is effective for treating typhoid or paratyphoid fevers. This is especially important where there are multiple-drug resistant strains. Azithromycin was better than some of the other drugs used. However, care will need to be taken to prevent strains becoming resistant to azithromycin too. More large trials, preferably multicentred and involving outpatients in areas endemic for enteric fever, are needed.
Effa, E.E.; Bukirwa, H. Azithromycin for treating uncomplicated typhoid and paratyphoid fever (enteric fever). Cochrane Database of Systematic Reviews (2008) (Issue 4) Art. No.: CD006083. [DOI: 10.1002/14651858.CD006083.pub2]