Wallace M R, Yousif A A, Mahroos G A, Mapes T, Threlfall E J, Rowe B, Hyams K C
Department of Internal Medicine, Naval Hospital, San Diego, California 92134-5000.
Eur J Clin Microbiol Infect Dis. 1993 Dec;12(12):907-10. doi: 10.1007/BF01992163.
A randomized trial comparing ceftriaxone (3 g given parenterally per day for 7 days) to ciprofloxacin (500 mg given orally twice a day for 7 days) in the treatment of blood culture positive typhoid fever was conducted. Twenty patients were openly randomized to receive ciprofloxacin and 22 to receive ceftriaxone. The outcome was classified as clinical failure in 6 patients (27%) in the ceftriaxone group, but in none in the ciprofloxacin group (p = 0.01). The mean duration of fever was four days in the ciprofloxacin group and about five days in the ceftriaxone group (p = 0.04). In the six patients in the ceftriaxone group who experienced failure, therapy was switched to ciprofloxacin and the patients became afebrile and asymptomatic within 48 hours. Patients with resistant strains of Salmonella typhi and patients with sensitive strains responded equally well to ciprofloxacin therapy. Analysis of a subset of 12 of the multiresistant strains revealed that resistance was encoded for by a transferable 180 kilobase plasmid. Ciprofloxacin represents a useful treatment option in areas where multiresistant strains are likely to be encountered.
开展了一项随机试验，比较头孢曲松（每日静脉注射3克，共7天）与环丙沙星（每日口服500毫克，分两次服用，共7天）治疗血培养阳性伤寒热的效果。20名患者被随机公开分组，其中20人接受环丙沙星治疗，22人接受头孢曲松治疗。结果显示，头孢曲松组有6名患者（27%）出现临床治疗失败，而环丙沙星组无一例失败（p = 0.01）。环丙沙星组发热的平均持续时间为4天，头孢曲松组约为5天（p = 0.04）。在头孢曲松组出现治疗失败的6名患者中，治疗改为环丙沙星后，患者在48小时内退热且无症状。伤寒杆菌耐药菌株患者和敏感菌株患者对环丙沙星治疗的反应同样良好。对12株多重耐药菌株的一个子集进行分析发现，耐药性由一个可转移的180千碱基质粒编码。在可能遇到多重耐药菌株的地区，环丙沙星是一种有用的治疗选择。
