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Antimicrobial Agents and Chemotherapy, June 1999, p. 1441-1444, Vol. 43, No. 6
0066-4804/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.

Azithromycin versus Ciprofloxacin for Treatment of Uncomplicated Typhoid Fever in a Randomized Trial in Egypt That Included Patients with Multidrug Resistance

Nabil I. Girgis,1 Thomas Butler,2,* Robert W. Frenck,1 Yehia Sultan3 Forrest M.  Brown,1 David Tribble,1 and Rasik Khakhria4

U.S. Naval Medical Research Unit No. 3, Cairo, Egypt1; Texas Tech University Health Sciences Center, Lubbock, Texas2; Abbassia Fever Hospital and Egyptian Ministry of Health, Cairo, Egypt3; and Bureau of Microbiology, Ottawa, Ontario, Canada4

Received 9 November 1998/Returned for modification 2 February 1999/Accepted 6 April 1999

To compare clinical and bacteriological efficacies of azithromycin and ciprofloxacin for typhoid fever, 123 adults with fever and signs of uncomplicated typhoid fever were entered into a randomized trial. Cultures of blood were positive for Salmonella typhi in 59 patients and for S. paratyphi A in 3 cases; stool cultures were positive for S. typhi in 11 cases and for S. paratyphi A in 1 case. Multiple-drug resistance (MDR; resistance to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole) was present in isolates of 21 of 64 patients with positive cultures. Of these 64 patients, 36 received 1 g of azithromycin orally once on the first day, followed by 500 mg given orally once daily on the next 6 days; 28 patients received 500 mg of ciprofloxacin orally twice daily for 7 days. Blood cultures were repeated on days 4 and 10 after the start of therapy, and stool cultures were done on days 4, 10, and 28 after the start of therapy. All patients in both groups improved during therapy and were cured. Defervescence (maximum daily temperatures of <= 38°C) occurred at the following times [mean ± standard deviation (range)] after the start of therapy: 3.8 ± 1.1 (2 to 7) days with azithromycin and 3.3 ± 1.0 (1 to 5) days with ciprofloxacin. No relapses were detected. Cultures of blood and stool during and after therapy were negative in all cases, except for one patient treated with azithromycin who had a positive blood culture on day 4. These results indicated that azithromycin and ciprofloxacin were similarly effective, both clinically and bacteriologically, against typhoid fever caused by both sensitive organisms and MDR S. typhi.

* Corresponding author. Mailing address: Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430. Phone: (806) 743-3155. Fax: (806) 743-3148. E-mail: medtcb{at}ttuhsc.edu.

Antimicrobial Agents and Chemotherapy, June 1999, p. 1441-1444, Vol. 43, No. 6
0066-4804/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.


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