Chloramphenicol typhoid fever treatment

Antibacterial treatment is generally not required in cases of gastroenteritis. Typhoid fever is treated with ciprofloxacin (quinolone), cefotaxime (third generation cephalosporin) or chloramphenicol. Impetigo necessitates the systemic use of flucloxacillin or erythromycin. Topical fusidic acid or mupirocin may also be used. 

Typhoid fever caused by Salmonella typhi or S. paratyphi is an important and prevalent cause of continuous fever without localizing symptoms in the tropics. The diagnosis can be confirmed with a bloodculture. Response on therapy is often seen only after 3 days when the fever subsides. Chloramphenicol-resistant Salmonella typhi was first described in Vietnam in 1973. Its prevalence reached 95% in the 1970s and then decreased to 54% in the 1980s after cotrimoxazole became the treatment of choice. In the mid-1993, there was a dramatic increase in the number of strains of S. typhi, isolated in the hospital and from patients in the outbreaks, which are resistant to the three first-line antibiotics chloramphenicol, cotrimoxazol and ampicillin. This indicated that there was an urgent need for effective antibiotics for the treatment of typhoid fever. 

Because of bone marrow toxicity of chloramphenicol, its use is restricted to the treatment of infection caused by S. typhi and paratyphi (treatment of typhoid fever). 

Chloramphenicol is used far the treatment of typhoid fever, bacterial meningitis, and certain anaerobic infections such as in the treatment of cystic fibrosis in children. 

Typhoid fever is a generalised infection and requires treatment with ciprofloxacin. Chloramphenicol, amoxicillin or co-trimoxazole are less effective alternatives. The i.v. route should be used at... 

The third-generation cephalosporins (e.g., ceftriaxone, ceflxime, cefotaxime, and cefoperazole) and azithromycin are also effective drugs for typhoid. Chloramphenicol, amoxicillin, and trimethoprim-sulfamethoxazole remain appropriate for the treatment of typhoid fever in areas of the world where the bacterium is still fully susceptible to these drugs and where the fluoroquinolones are not available or affordable. Although fluoroquinolones are not recommended in children, the pediatric use of ciprofloxacin in areas where multidrug-resistant S. typhi occurs is acceptable. In pregnant women, the p lactam antibiotics are safe, and there are some case reports to support fluoroquinolone use. 

Antibiotics indicated in the treatment of typhoid fever are ceftriaxone 1 g/kg M or IV b.i.d. and fluoroquinolones such as ciprofloxacin 500 mg PO b.i.d. or levofloxa-cin 500 mg or IV for 10-14 days. Fluroquinolones may be also administered in children. Chloramphenicol is still used but aplastic anemia is a consideration. Other antibiotics which are used depending on sensitivity are trimethoprin-sulfamethoxazole, amoxicillin, ampicillin, azithromycin and aztreonam. 

Butler and colleagues demonstrated that azithromycin was effective in treating 86% of 43 bacteremic adults with typhoid fever and was as effective as chloramphenicol-treated patients (88% of 33 improved). All 83 Salmonella strains in this study were susceptible to azithromycin, and all bacteremias were cleared by day 8 of therapy in both treatment groups [259]. On the other hand, Wallace et al. reported treating four adults with typhoid fever with azithromycin [3]. All patients were bacterentic with Salmonella typhi, and three of four failed therapy. It was postulated that low azithromycin serum levels might be inadequate to treat bacteremic patients with typhoid fever. Additional studies are needed before a recommendation can be made for azithromycin as first-line therapy in typhoid fever. 

Third-generation cephalosporins and quinolones are drugs of choice for the treatment of typhoid fever. The adult dose of chloramphenicol for typhoid fever is 1 g every 6 hours for 4 weeks. 

Salmonella paratyphi is a bacterial enteric (intestinal) infection with an abrupt outbreak, which produces the following symptoms continued fever, headache, malaise, enlarged spleen, rose spots on the trunk of the body, and diarrhea. These symptoms are similar to those of typhoid fever, but the death rate is much lower. Mild and asymptomatic infections may also occur upon exposure. Outbreaks and locations are similar to those of the other salmonella bacteria. The infectious dose is 1000 organisms by ingestion. Transmission occurs by direct or indirect contact with feces or, in rare cases, urine of patients or carriers. It is spread by food, especially miUc and dairy products, shellfish, and in some isolated cases, water supplies. Incubation depends on the strength of the dose, but usually 1-3 weeks for enteric fever and 1-10 days for gastroenteritis. Antibiotic treatment with chloramphenicol, ampicillin, or TMP-SMX is usually effective. 

Chloramphenicol an antibiotic, M, 323, from Streptomyces venezuelae. There are 4 stereoisomers, of which only D(-)-threo-C. (Fig.) is an antibiotic. C. inhibits protein synthesis on 70S ribosomes of prokaryotes, and on the mitochondrial ribosomes of eukaryotic cells. Protein synthesis on SOS eukaryotic ribosomes is not affected. C. inhibits peptide bond formation and peptidyl transferase activity on the 50S ribo-somal subunit, by specifically binding to one of the SOS ribosomal proteins involved in these reactions. The protein in question is probably localized in the acceptor-donor region of the ribosome. C. is used as a broad-spectrum antibiotic in the treatment, e.g. of typhoid fever, paratyphus, spotted fever, infectious hepatitis, dysentery, phtheiia and viral influenza . Because it inhibits protein synthesis in mitochondrial ribosomes, C. is relatively toxic. It is now produced entirely synthetically. 

Chloramphenicol (Parke-Davis, 1949) was obtained from the soil bacterium Streptomyces venezuelae. Its use as a systemic treatment is restricted to very severe infections such as typhoid fever when careful clinical assessment indicates that no other antibiotic is effective. This is because it is known to have toxic effects on bone marrow. However, it is used topically for infections of the ear, skin and eye. Its mode of action is by the inhibition of bacterial protein synthesis. 

Chloramphenicol - Chloramphenicol Is considered the drug of choice for treatment of typhoid fever, but recently R-factor mediated resistant strains of Salmonella typht have appeared in epidemics In Mexlcol53 los Angelesl54 and Viet Nam.155 in staphylococci, chloramphenicol resistance has been shown to be caused by acetyltransferases of 4 distinct types, each existing as a tetramerlc protein with a molecular weight of 80,000 and an Identical subunit size of 20,400,156... 

Chloramphenicol (Fig. 8.24) is an antibacterial agent that is used topically to treat infections of the eye and ear, but systemic treatment is reserved for treatment of life-threatening diseases such as those caused by Haemophilus influenzae and typhoid fever. Systemic administration through oral or parenteral delivery poses several problems chloramphenicol has a very bitter taste that cannot be masked effectively by conventional flavouring agents, which means there are therefore formulation problems that are needed to overcome poor patient acceptance. Additionally, poor water solubility makes formulation as an aqueous solution for parenteral administration difficult. Formation of the palmitate ester renders the compound virtually tasteless, and, whilst it remains relatively insoluble in water, it can be formulated as an oral suspension to enable good patient acceptance. Enzymatic... 

Chloramphenicol remains a major treatment of typhoid and paratyphoid fever in developing countries. However, with increasing resistance to ampicillin, trimethoprim-sulfamethoxazole and, to some extent, chloramphenicol, fluoroquinolones and some third-generation cephalosporins (e.g., ceftriaxone) have become the drugs of choice. Salmonella infections, such as osteomyelitis, meningitis and septicemia, have also been indications for chloramphenicol use. Nevertheless, antibiotic resistance patterns can be a problem. As noted previously, nonty-phoidal salmonella enteritis is not benefited by treatment with chloramphenicol or other antibiotics. 

E. Chloramphenicol is no longer the treatment of choice for any bacterial infection because of the potentially fatal chloramphenicol-induced bone marrow suppression. In the past it has been used against the infections indicated in choices A, B, C, and D. It remains a major treatment for typhoid and paratyphoid fever in some developing countries, since alternative drugs are much more expensive. 

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