Summary
The efficacy of chloramphenicol in curing enteric fever and eradicating Salmonella is compared with that of trimethoprim-sulphamethoxazole (TMP-SMZ) and two β-lactam antibiotics (pivampicillin and FL 1060). Nine cases caused by S. typhi and 39 caused by S. paratyphi B were studied. The duration and severity of fever and gastrointestinal symptoms was not significantly different between the three treatment groups. Mean duration of symptoms was 5.9, 4.2, and 4.4 days, respectively. Relapse of the symptoms was seen in only two patients treated with chloramphenicol. The mean period of Salmonella excretion after cessation of therapy was statistically significantly longer in patients treated with chloramphenicol (22 days) than in the other groups (14 and 15 days respectively). The proportion of patients treated with either TMP-SMZ or β-lactam antibiotics which became chronic Salmonella carriers was not significantly larger than that previously observed in patients not treated with antibiotics but four out of 12 patients treated with chloramphenicol became carriers. The emergence of resistant and R+ enteric bacteria, pathogenic, and especially non-pathogenic strains, was much more frequent after chloramphenicol therapy than after treatment with TMP-SMZ or β-lactam antibiotics. It is suggested that drug resistance in S. typhi has ensued through frequent use of chloramphenicol in areas endemic for typhoid. The results in this series indicate that the usefulness of chloramphenicol in the treatment of enteric fever should be reconsidered.
Zusammenfassung
Es wird die Wirkung von Chloramphenicol mit derjenigen von Trimethoprim-Sulphamethoxazol (TMP-SMZ) und zwei β-Lactam-Antibiotika (Pivampicillin und FL 1060) im Hinblick auf den klinischen Therapieerfolg bei Salmonellosen und die Beseitigung von Salmonellen-Ausscheidern verglichen. Das Krankengut bestand aus neun Typhus- und 39 Paratyphus-B-Fällen. Die Dauer und Schwere des Fiebers und der gastrointestinalen Erscheinungen unterschieden sich nicht signifikant zwischen den drei Behandlungsgruppen. Die Symptome wiesen im Mittel eine Dauer von 5,9, 4,2 bzw. 4,4 Tagen auf. Ein klinisches Rezidiv wurde nur bei zwei mit Chloramphenicol behandelten Patienten beobachtet. Die mittlere Dauer der Salmonella-Ausscheidung nach Therapieende war bei Patienten, die mit Chloramphenicol behandelt wurden, statistisch signifikant länger als bei den anders behandelten. Der Anteil der Patienten, die entweder mit TMP-SMZ oder mit β-Lactam-Antibiotika behandelt und die zu Dauerausscheidern wurden, war nicht signifikant größer als derjenige von früher behandelten Patienten, die überhaupt keine Antibiøtika bekamen. Vier von 12 Patienten, die Chloramphenicol bekamen, wurden jedoch zu Ausscheidern Das Auftreten von resistenten bzw. enteralen Bakterien mit R-Faktoren, und zwar besonders von nichtpathogenen, war häufiger nach Chloramphenicol-Behandlung als nach Behandlung mit TMP-SMZ oder β-Lactam-Antibiotika. Es wird vermutet, daß die Antibiotika-Resistenz von S. typhi durch den häufigen Gebrauch von Chloramphenicol in Gebieten mit endemischem Typhus hervorgerufen wurde. Die Ergebnisse dieser Untersuchung weisen darauf hin, daß die Zweckmäßigkeit der Chloramphenicol-Anwendung bei Typhus-Erkrankung überprüft werden sollte.
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Jonsson, M. Is chloramphenicol the drug of choice for the treatment of enteric fever?. Infection 2, 145–151 (1974). https://doi.org/10.1007/BF01642235
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DOI: https://doi.org/10.1007/BF01642235