Acharya G, Butler T, Ho M, Sharma P R, Tiwari M, Adhikari R K, Khagda J B, Pokhrel B, Pathak U N
Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
Am J Trop Med Hyg. 1995 Feb;52(2):162-5. doi: 10.4269/ajtmh.1995.52.162.
To compare the efficacy of a short course of ceftriaxone with a standard course of chloramphenicol for typhoid fever, a randomized trial was conducted in 46 patients (30 adults and 16 children) who were blood culture-positive for Salmonella typhi or S. paratyphi. Ceftriaxone was given intravenously once a day for three days to 15 adults at a dose of 2 g/day and to eight children at a dose of 50 mg/kg/day. Chloramphenicol was given orally four times a day to an equal number of patients at a dose of 60 mg/kg/day until defervescence, followed by 40 mg/kg/day for a total of 14 days. Clinical cure without complications or relapse occurred in 19 patients (83%) treated with ceftriaxone and in 20 patients (87%) treated with chloramphenicol (P > 0.05). Four patients with clinical failures in the ceftriaxone group included two with fever lasting six days or more, one with altered sensorium, and one with relapse; three patients treated with chloramphenicol developed leukopenia and thrombocytopenia and were switched to amoxicillin therapy. Bacteriologically, blood cultures of all 46 patients were sterile three days after the start of treatment, and remained so through day 15 of follow-up. These results extend previous observations on the efficacy of ceftriaxone in short courses for both adults and children with typhoid fever.
为比较短疗程头孢曲松与标准疗程氯霉素治疗伤寒的疗效，对46例血培养伤寒沙门菌或副伤寒沙门菌阳性的患者（30例成人和16例儿童）进行了一项随机试验。15例成人患者以2 g/天的剂量、8例儿童患者以50 mg/kg/天的剂量静脉注射头孢曲松，每日1次，共3天。同等数量的患者口服氯霉素，剂量为60 mg/kg/天，每日4次，直至退热，之后以40 mg/kg/天的剂量服用，共14天。接受头孢曲松治疗的19例患者（83%）和接受氯霉素治疗的20例患者（87%）临床治愈，无并发症或复发（P>0.05）。头孢曲松组4例临床治疗失败的患者中，2例发热持续6天或更长时间，1例意识改变，1例复发；3例接受氯霉素治疗的患者出现白细胞减少和血小板减少，转而接受阿莫西林治疗。细菌学检查显示，所有46例患者在治疗开始3天后血培养均无菌，且在随访的第15天一直保持无菌。这些结果扩展了先前关于头孢曲松对成人和儿童伤寒短疗程疗效的观察。
