DefinePK

Research Objective

To evaluate the efficacy of azithromycin as a first-line therapy and the combination of meropenem and azithromycin as the second-line therapy in treating pediatric patients with extensively drug-resistant (XDR) Salmonella Typhi in Abbottabad, Pakistan.

Methodology

This retrospective cross-sectional study was conducted at the Department of Pediatrics, Abbottabad International Medical Complex, Pakistan, from May 2022 to January 2024. Children aged 1-15 years clinically diagnosed with typhoid fever and confirmed XDR Salmonella Typhi infection via blood culture were included. Patients received azithromycin as initial treatment. If there was no response, they received a combination therapy of meropenem and azithromycin. Primary outcomes were clinical recovery, recurrence within 30 days, and adverse effects. Data were analyzed using SPSS version 24.

Methodology Flowchart

                        graph TD
    A["Identify Pediatric Patients with Typhoid Fever"] --> B["Blood Culture Confirms XDR Salmonella Typhi"];
    B --> C["Initiate Azithromycin Monotherapy"];
    C --> D["Assess Clinical Response"];
    D -- No Response --> E["Add Meropenem to Azithromycin Combination Therapy"];
    D -- Response --> F["Continue Azithromycin Monotherapy"];
    E --> G["Assess Clinical Recovery"];
    F --> G;
    G --> H["Monitor for Recurrence and Adverse Effects"];
    H --> I["Analyze Data and Draw Conclusions"];                    

Discussion

Azithromycin monotherapy demonstrated high clinical recovery rates for XDR Salmonella Typhi in pediatric patients. The combination therapy with meropenem was effective for patients who did not respond to azithromycin alone. The significantly shorter fever clearance time with monotherapy suggests its primary efficacy, while the combination therapy addresses more severe or resistant cases. Minimal adverse effects were observed, supporting the safety of these regimens.

Key Findings

Of 67 pediatric patients, 57 (85.1%) recovered with azithromycin monotherapy. The remaining 10 (14.9%) who did not respond to azithromycin alone recovered with the addition of meropenem. The mean duration of defervescence was significantly lower with azithromycin monotherapy (4.80 ±0.58 days) compared to combination therapy (12.90 ±1.10 days) (p-value <0.001). Mild nausea was the only observed adverse event in 43.3% of patients.

Conclusion

Azithromycin monotherapy is effective and safe for treating pediatric XDR Salmonella Typhi, showing a high clinical recovery rate and a significant reduction in fever duration compared to combination therapy with meropenem. Mild nausea was the primary adverse effect.

Fact Check

* A total of 67 pediatric patients were included in the study.
* Azithromycin monotherapy achieved clinical recovery in 85.1% of patients.
* The mean duration of defervescence was 4.80 ±0.58 days for azithromycin monotherapy versus 12.90 ±1.10 days for combination therapy.

Mind Map