Efficacy of Azithromycin in Enteric Fever in Children

Saima Jamil; Anis ur Rahman; Afnan Shamraiz

doi:10.70749/ijbr.v3i5.1364

Authors

Saima Jamil Department of Pediatrics, Abbottabad International Hospital, Abbottabad, KP, Pakistan.
Anis ur Rahman Department of Pediatrics, Abbottabad International Hospital, Abbottabad, KP, Pakistan.
Afnan Shamraiz Department of Pediatrics, Abbottabad International Hospital, Abbottabad, KP, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v3i5.1364

Keywords:

Enteric Fever, Azithromycin, Salmonella Typhi, Treatment Efficacy

Abstract

Background: Enteric fever remains a significant child health condition, and effective and early use of antibiotics is crucial to reduce morbidity. Azithromycin is widely employed due to its favorable pharmacokinetics and intracellular activity against Salmonella typhi. Treatment outcomes according to different demographics and clinical syndromes should be investigated further. Objective: To determine the efficacy of Azithromycin in children with enteric fever at Abbottabad international hospital. Study Design: Descriptive cross-sectional study. Duration and Place of Study: Conducted from June 2024 to December 2024 at the Department of Pediatrics, Abbottabad International Hospital, Abbottabad. Methodology: A total of 87 children aged 3–15 years with culture-confirmed enteric fever were enrolled. All participants received supervised oral azithromycin at 20 mg/kg/day for five days. Clinical efficacy was defined as complete symptom resolution within seven days of therapy initiation. Data on demographic characteristics, clinical parameters, and treatment outcomes were collected and analyzed using appropriate statistical tests. Results: The average was 8.17 ± 3.54 years, and 73.6% of them were males. The overall efficacy was 75.9%. Duration of fever was significantly correlated with success of treatment; 92.6% was seen in patients with fever ≤10 days, while 48.5% was observed in patients having fever for more than 10 days (p=0.000). No correlation was observed for efficacy and age, gender, weight, socioeconomic status, or place of residency. Conclusion: Azithromycin is effective for the treatment of enteric fever among children, and early initiation of treatment produces better clinical outcomes.

Downloads

Download data is not yet available.

References

Kim, C., Goucher, G., Tadesse, B. T., Lee, W., Abbas, K., & Kim, J.-H. (2023). Associations of water, sanitation, and hygiene with typhoid fever in case–control studies: a systematic review and meta-analysis. BMC Infectious Diseases, 23(1).

https://doi.org/10.1186/s12879-023-08452-0

Xie, L., Ming, L., Ding, M., Deng, L., Liu, M., & Cong, Y. (2022). Paratyphoid Fever A: Infection and Prevention. Frontiers in Microbiology, 13.

https://doi.org/10.3389/fmicb.2022.945235

Veronese, P., Pappalardo, M., Maffini, V., Rubini, M., Giacometti, A., Ruozi, M. B., Cella, S., & Dodi, I. (2023). Severe Typhoid Fever Complicated by Superior Mesenteric and Splenic Vein Thrombosis. Infectious Disease Reports, 15(4), 377–385.

https://doi.org/10.3390/idr15040038

Saha, T., Arisoyin, A. E., Bhaswanth Bollu, Ashok, T., Babu, A., Issani, A., Jhaveri, S., & Chaithanya Avanthika. (2023). Enteric Fever: Diagnostic Challenges and the Importance of Early Intervention. Cureus, 15(7).

https://doi.org/10.7759/cureus.41831

Kuehn, R., Stoesser, N., Eyre, D., Darton, T. C., Basnyat, B., & Parry, C. M. (2022). Treatment of enteric fever (typhoid and paratyphoid fever) with cephalosporins. Cochrane Database of Systematic Reviews, 2022(11).

https://doi.org/10.1002/14651858.cd010452.pub2

Khan, M., Khattak, M. T., Gul, A., Riaz, M., & Zahra, F. T. (2024). A comparable risk of extensively drug-resistant typhoid fever in the pediatric cohort during the COVID-19 pandemic. PubMed, 18(1), 24–28.

Veeraraghavan, B., Pragasam, A. K., Ray, P., Kapil, A., Nagaraj, S., Perumal, S. P. B., ... & Kang, G. (2021). Evaluation of antimicrobial susceptibility profile in Salmonella typhi and Salmonella paratyphi A: presenting the current scenario in India and strategy for future management. The Journal of Infectious Diseases, 224(Supplement_5), S502-S516.

https://doi.org/10.1093/infdis/jiab144

Jabeen, K., Saleem, S., Jahan, S., Nizamudin, S., Arshad, F., Huma, Z.-E., Syed Mohsin Raza, Mehmood, M., Roman, M., & Faiz Ul Haq. (2023). Molecular Characterization of Extensively Drug Resistant Salmonella Enterica Serovar Typhi Clinical Isolates from Lahore, Pakistan. Infect Drug Resist, 16, 2987–3001.

https://doi.org/10.2147/idr.s406253

Heidary, M., Ebrahimi Samangani, A., Kargari, A., Kiani Nejad, A., Yashmi, I., Motahar, M., Taki, E., & Khoshnood, S. (2022). Mechanism of action, resistance, synergism, and clinical implications of azithromycin. Journal of Clinical Laboratory Analysis, 36(6).

https://doi.org/10.1002/jcla.24427

O’Brien, K., Sié, A., Dah, C., Ourohiré, M., Ouedraogo, M., Boudo, V., Arzika, A., Lebas, E., Nyatigo, F., Godwin, W., Kelly, J., Arnold, B., & Oldenburg, C. (2022). Comparing azithromycin to Amoxicillin in the management of uncomplicated severe acute malnutrition in Burkina Faso: A pilot randomized trial. The American Journal of Tropical Medicine and Hygiene.

https://doi.org/10.4269/ajtmh.21-1023

Frenck, Jr., R., Mansour, A., Nakhla, I., Sultan, Y., Putnam, S., Wierzba, T., Morsy, M., & Knirsch, C. (2004). Short‐course azithromycin for the treatment of uncomplicated typhoid fever in children and adolescents. Clinical Infectious Diseases, 38(7), 951-957.

https://doi.org/10.1086/382359

Rao, K. N., Pratyusha, R., & Acharya, A. (2020). Azithromycin and ceftriaxone in uncomplicated typhoid fever in paediatric patients: a prospective, comparative and randomized open labelled trail. International Journal of Contemporary Pediatrics, 7(12), 2316–2320.

https://doi.org/10.18203/2349-3291.ijcp20205091

Nagaraj, P., Manickam, K., Kumar, S., Kumar, S., Sampath, S., & Shobhana Sivathanu. (2016). To Study the Effectiveness of Oral Azithromycin as Compared to Parenteral Ceftriaxone in the Treatment of Uncomplicated Enteric Fever. Journal of Pediatric Infectious Diseases, 11(04), 113–117.

https://doi.org/10.1055/s-0036-1593889

Islam, M. A., Mobarak, M. R., Hasan, A. R., & Hanif, M. (2015). Clinical Efficacy of Azithromycin in Typhoid and Paratyphoid Fever in Children. Journal of Enam Medical College, 5(1), 34–38.

https://doi.org/10.3329/jemc.v5i1.21495

Ujjan, R. A., Shaikh, G. S., Pathan, S., Niamat, M., Shaikh, F., & Ali, K. (2024). The Effectiveness of Azithromycin versus Cefixime in the Treatment of Typhoid Fever in Children. Pakistan Journal of Health Sciences, 5(10), 179–183.

https://doi.org/10.54393/pjhs.v5i10.2105

Akram, M., Ain, Q. ul, Tariq, A., Javed, S., Nayab, K., & Fatima, S. (2025). Comparison of Efficacy of Azithromycin with Ciprofloxacin in the Treatment of Uncomplicated Enteric Fever in Children. Journal of Rawalpindi Medical College, 28(4).

https://doi.org/10.37939/jrmc.v28i4.2619

Riaz A, Malik AU, Zahoor F. Role of azithromycin in the treatment of typhoid fever in children. PJMHS. 2013;7(4):1118-1120.

Khan, A., Khan, I., Babar, A. N., Khan, Y., Shah, G., & Khan, M. I. (2024). Effectiveness of Oral Azithromycin in Treating Enteric Fever: A Hospital-Based Study on Pediatric Patients. Cureus, 16(8).

https://doi.org/10.7759/cureus.67024

Faryad, N., Riaz, L., Hanif, H. H., Tariq, A., Asghar, M., & Raza, S. M. A. (2022). Efficacy of Oral Azithromycin in Treatment of Uncomplicated Enteric Fever in Children. Pakistan Journal of Medical & Health Sciences, 16(07), 301-301.

https://doi.org/10.53350/pjmhs22167301