Clinical Outcome of Single Antibiotic versus Combination Antibiotics in Enteric Fever

Original Research Article Background: In recent times the treatment of enteric fever is becoming more and more difficult. The aim of our study was to find out a cost effective way of treatment of enteric fever and to determine the success rate & fever clearance time of ceftriaxone as monotherapy in comparison to combinations of cefixime plus azithromycin. Method: Randomized single blind controlled comparative experimental study carried out in the Department of Medicine, Uttara Adhunik Medical College & Hospital, and Dhaka, Bangladesh during the period from 1 st September, 2015 to 1 st September, 2015. A total 96 cases of enteric fever patients were included based on inclusion and exclusion criteria. After taking informed written consent data was collected by a questionnaire and relevant investigations were done. Control group were given inj ceftriaxone and experimental group were given cefixime plus azithromycin. Then collected data was analyzed. Main Outcome measures: Age, Sex, response of treatment of Fever, Myalgia, Headache, Anorexia, Constipation, Diarrhoea, Abdominal pain, Cough, Relative bradycardia, Rose spot on trunk, Splenomegaly, Hepatomegaly, Coated tongue and treatment failure. Results: Out of 96 cases majority of cases were seen in the age group of 18-25 years (30.20%), followed by 26-33 years (23.95%). There was a slight male preponderance with 53.1% male and 46.9 % female. Majority (47.92%) of cases were brought to hospital during the 1 st week of illness. Fever was common to all (100%) cases, followed by headache (62.5%), anorexia, and nausea (62.5%), abdominal pain (58.33%), diarrhoea (52.08%), and constipation (29.16%) and vomiting (8.33%). Less common symptoms were cough (14.58%), generalized weakness (8.33%), jaundice (4.16%), and bloody diarrhoea (2.08%). None of the patients had G.I bleeding or rash. Coated tongue was present in 83.33% patient. Hepatomegaly was present in 66.66% patients and more common than splenomegaly (41.66%). Only 41.66% patients were of toxic looking. Abdominal tenderness was present in 25% patients, while abdominal distention in 18.75%. Caecal gurgling and relative bradycardia in 10.41% each. Mean period of defervescence was 5.4±1.09 days for Ceftriaxone group and 4.2+ 0.91 days for Cefixime plus Azithromycin group, which is statistically significant. (p = .04). Duration of therapy was 9.92+ 4 days in group A and 7+ 0.00 days in group B, this is statistically significant. (p < 0.001). Out of 48 cases in group A, 44 patients become afebrile with ceftriaxone treatment, success rate is 91.67%. Out of 48 cases of group B, 2 patients failed to respond and success rate is 95.83% ,but this is not statistically significant (p = 0.399). Conclusion: The treatment of enteric fever with a combination of antibiotics like Cefixime plus Azithromycin is not inferior to single antibiotic like Ceftriaxone but oral combinations of antibiotic provide a less costly and equally safe and effective oral form of treatment alternative to ceftriaxone. Findings of this were also in accordance with the previous studies with enteric fever. As a small number of patients were studied so findings of this study should be cautiously extrapolated into the broader context.