Cefixime-ofloxacin Combination in the Management of Uncomplicated Typhoid Fever in the Indian Community Setting

摘要

Antimicrobial resistance is a global problem and is definitely a cause of concern inIndia too, in the context of typhoid fever. It is becoming clearer that monotherapyis not effective for typhoid fever and the option to be considered is combinationtherapy. There are very few antibiotic combinations that are approved andbacked by clinical evidence, available in India for the treatment of typhoid fever.Cefixime-ofloxacin combination is approved by Indian Regulatory Authority andhas a good body of clinical evidence in the current Indian context. In-silico studieshave demonstrated positive rationale of combining these two drugs, while in-vitrostudies have substantiated the same by showing a strain specific synergistic andor additive activity between the two drugs against S. typhi. Clinical studies inIndian patients have shown multiple benefits of using this combination in typhoidfever such as a quick time to defervescence (~3 days), complete clinical cure in ~7days, effective symptomatic relief, efficacy in relapse cases and a reduced need forhospitalization. The drug combination also demonstrates a very good tolerabilityprofile. Recommendations of the Association of physicians of India also back thiscombination in typhoid fever. Thus, in the current era of emerging antibioticresistance, cefixime-ofloxacin is a safe, effective and reliable treatment optionfor clinicians to treat uncomplicated typhoid in the Indian community setting.