A Prospective Study of Efficacy and Safety of Azithromycin and Ofloxacin in the treatment of Typhoid Fever in Children at a Tertiary Care Hospital

Introduction: Antimicrobial therapy is the mainstay for the treatment of Typhoid fever that shortens the clinical course of typhoid fever and reduces the risk of death. For decades, chloramphenicol has been highly effective against S. typhi, but multi-drug resistant (MDR) strains of S. typhi (resistant to chloramphenicol, trimethoprim sulfamethoxazole, and ampicillin) has restricted its use in typhoid fever. Objective: To compare the efficacy and safety of Azithromycin and Ofloxacin in children suffering from uncomplicated typhoid fever. Methods: Blood culture proven, uncomplicated typhoid fever patients admitted in the pediatric ward of J. N. Medical college, Aligarh were treated with ofloxacin orally (15mg/kg/24 hrs BD for 5 days) and azithromycin orally (10mg/kg/24 hrs OD on Day 1, then 5mg/kg OD for next 4 days). Patients were clinically and bacteriologically evaluated during the study period and follow-up. Results: 96.7 % cure rate was observed in azithromycin group. No relapse was recorded. Conclusion: Both Ofloxacin as well as azithromycin may be considered as an empirical therapy for  the  treatment of uncomplicated  typhoid in  children .

Clindamycin induced Cutaneous Drug Reaction – A Case Report

Adverse drug reactions (ADRs) due to antibiotics is one of the major concern. Hypersensitivity reactions with clindamycin may be immediate or delayed type, but their frequency and severity are relatively rare. We here report a case of a 32-year-old male patient with road traffic accident, who later developed osteomyelitis of occipital bone. After two weeks of therapy and debridement, the patient was on maintenance therapy receiving clindamycin 300 mg q8h, ciprofloxacin 500 mg q12 h and rifampicin 450mg fasting. After six days, he developed erythematous maculopapular rashes, initially on the trunk followed by neck and arm of both upper limbs with limitation of movement, fever, chills and night sweats. The reaction subsided after withdrawal of clindamycin and administering i.v. hydrocortisone 100mg stat followed by tablet promethazine 25mg 12hourly for 3 days. The causality assessment was done as per WHO-UMC scale and it was “probable” in this case. Although the incidence of clindamycin induced drug reaction is rare, the clinicians should be aware of such reactions before prescribing it.