Treatment of typhoid fever with azithromycin versus chloramphenicol in a randomized multicentre trial in India.

To compare the clinical and bacteriological efficacies of azithromycin and chloramphenicol for treatment of typhoid fever, 77 bacteriologically evaluable adults, with blood cultures positive for Salmonella typhi or Salmonella paratyphi A susceptible to their assigned drugs, were entered into a randomized open trial at four hospitals in India. Forty-two patients were randomized to receive azithromycin 500 mg p.o. od for 7 days and 35 to receive chloramphenicol 2-3 g p.o. od in four divided doses for 14 days. Thirty-seven patients (88%) in the azithromycin group responded with clinical cure or improvement within 8 days and 30 patients (86%) in the chloramphenicol group responded with cure or improvement. By day 14 after the start of treatment, all patients treated with azithromycin and all except two of the patients treated with chloramphenicol (94%) were cured or improved. Blood cultures repeated on day 8 after start of therapy showed eradication of organisms in 100% of patients in the azithromycin group and 94% of patients in the chloramphenicol group. By day 14 the eradication rate in the chloramphenicol group had increased to 97%. Stool cultures on days 21 and 35 after start of treatment showed no prolonged faecal carriage of Salmonella spp. in either group. These results indicate that azithromycin given once daily for 7 days was effective therapy for typhoid fever in a region endemic with chloramphenicol-resistant S. typhi infection and was equivalent in effectiveness to chloramphenicol given to patients with chloramphenicol-susceptible infections.

Resurgence of malaria and drug resistance in plasmodium falciparum and plasmodium vivax species in Bombay.

Malaria had been well controlled in Bombay, through control of mosquito breeding sites and legal provisions. However in the past 2-3 years there has been a marked increase in incidence of malaria in Bombay. The objective of the present study was to assess the incidence of drug resistance of malarial parasite to standard drugs. The study was an outpatient study, but drug administration was supervised, blood smear was read by experienced technicians counting at least 100 fields. Follow up was done upto day 14 as beyond that, smear positivity due to reinfection cannot be ruled out. Two hundred cases; 56 of P. falsiparum, 139 of P. vivax and 5 with mixed infection were investigated. The public health department strategy of administering single dose of (10 mg/kg) chloroquine found to be largely effective in the past was now found to be only partially effective, with 20/56 Pl. falciparum, 7/139 P. vivax and 1/5 mixed infection cases showing smear positive on day 6 or day 14. These patients, resistant to single dose chloroquine, were then treated with full dose of (25 mg/kg) chloroquine. Three out of 20 cases of P. falciparum and 1/7 P. vivax cases did not respond to full dose (25 mg/kg) of chloroquine. These 3 chloroquine resistant cases of P. falciparum responded to Sulfadoxinepyrimethamine while the single case of chloroquine resistant P. vivax did not respond to quinine or sulfadoxinepyrimethamine.

A prospective survey of drug induced hepatotoxicity in a large hospital.

A prospective survey of laboratory records was carried out to identify the extent of drug induced hepatotoxicity in a hospital population. Eleven of 1000 (1.1%) abnormal liver function tests were due to drug induced hepatotoxicity. Anti-tubercular drugs, viz isoniazid, rifampicin and pyrazinamide were responsible for all cases of serious hepatotoxicity.