Effectivity versus sensitivity of Azithromycin in the treatment of uncomplicated enteric fever in children both in vitro and vivo: A clinical trial at Dhaka Shishu Hospital

Mohammed Reaz Mobarak1, Atiqul Islam2, Manzoor Hussain3, Jotsna Ara Begum4,
Mohammad Abdullah Al Mamun5, Md. Darul Islam6
Abstract
Background: Researches showed Azithromycin is highly effective in the treatment
of uncomplicated typhoid fever. Very few studies have been carried out in Bangladesh
to see the effectiveness and sensitivity-pattern of Azithromycin in children.
Objective: To determine whether in-vitro sensitivity test predicts the treatmentoutcome
of Azithromycin in uncomplicated enteric fever.
Methodology: This study was conducted from January 2009 to December 2009 in
Dhaka Shishu Hospital. Children between 2-12 years of age with characteristic clinical
presentation (e.g. fever, toxic appearance, abdominal tenderness, hepato or
splenomegaly, coated tongue, diarrhea or constipation etc.) of uncomplicated enteric
fever with blood culture positive for S. typhi or S. paratyphi were included in the
study. Patients were treated with Azithromycin orally at dose of 20mg/kg/day for 7
days. Effectiveness and sensitivity pattern were documented.
Results: Among the patients treated with Azithromycin, 22% were below 5 years,
78% were above 5 years. The average time of defervescence was 4.44±1.25 days. Overall
improvement rate was 94% with Azithromycin treatment. The occurrence of
complication was very low with Azithromycin in paediatric enteric fever. Among the
study subjects treated with Azithromycin 18% were found to be resistant to
Azithromycin. In Azithromycin sensitive cases 97.6% showed improvement and in
resistant cases 77.8% showed improvement.
Conclusion: Current study recommends that Azithromycin is effective in the treatment
of enteric fever in children. Azithromycin can be given to children with enteric fever
irrespective of its in-vitro sensitivity.

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