Efficacy of cefixime in the therapy of typhoid fever.

In 1948 John Woodward successfully used chloramphenicol to treat patients with typhoid fever (TF )[1]. After this accomplishment, the first choice for the therapy of TF was chloramphenicol until the 1970s, when the first outbreaks of infection by antibiotic-resistant bacteria appeared. The loss of sensitivity by Salmonella typhi to the antibiotics used for the treatment of typhoid fever was noted in the years following the beginning of antimicrobial therapy. Resistant strains frequently are resistant to chloramphenicol, trimethoprim-sulfamethoxasole and ampicillin. Resistance to these drugs is called multi-drug resistance (MDR). In places with high incidence of MDR strains of Salmonella typhi, quinolones like ciprofloxacin are the chosen agents for the treatment of TF. Recently, some countries have reported an increased of resistance to these antibiotics.[2] Unfortunately, quinolones are contraindicated in pediatric patients and pregnant woman due to the potential damage to the articular cartilage. Additionally, the wide use of quinolones in the treatment and prophylaxis of different diseases contribute to the appearance of S. typhi resistant to ciprofloxacin [3,4]. In the search for alternative antibiotics for the treatment of typhoid fever, the third generation cephalosporins have shown good activity against S. typhi [5]. However, only cefixime and cefpodoxime proxetil allow oral administration for use in ambulatory patients. Cefixime is a third generation cephalosporin, for oral use in children and adults, administered once or twice daily with good antimicrobial activity against S. typhi. Due the emergence of MDR S. typhi in endemic countries, alternative drugs for the treatment of typhoid fever are required. We conducted this study to assess the efficacy of cefixime in the treatment of TF.