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The Diagnosis, Treatment and Management of Typhoid Fever and the Role of Fluoroquinolones

R.H.H. Nelwan, MD
Professor, Chief Division of Tropical and Infectious Diseases,
Department of Internal Medicine, Faculty of Medicine University of Indonesia


Typhoid fever remains prevalent in varying degrees throughout the developing world, resulting in a substantial economic and social burden through the loss of income and possible loss of life. The efficacy of older fluoroquinolones has been proven and some fluoroquinolones have been recommended as the drug of choice for the treatment of typhoid fever. In our clinical study, we evaluated the safety and efficacy of levofloxacin due to its excellent activity, as defined by minimum inhibitory concentrations (MICs), against all Salmonella spp., the principle cause of typhoid fever.
Fifty-three adult hospitalized male and female patients with suspect typhoid fever were screened and those without complications, serious underlying conditions, or pregnancy or lactation were enrolled in the study. The 48 enrolled patients were given levofloxacin 500 mg o.d. for a period of one week. Diagnosis was confirmed by positive blood culture, polymerase chain reaction (PCR), or serology in 30 patients (11 males and 19 females) aged 18-58 years. All patients had a history of fever lasting 1-10 days; the mean was 6.1 days.
All patients showed excellent clinical response to treatment, becoming afebrile at an average of 2.43 days in confirmed cases (n = 21) and 2.22 days in probable cases (n = 9). We noted adverse skin reactions of possible allergic nature in two cases (4.2%). It can be concluded that the clinical efficacy and safety of levofloxacin in our clinical study was excellent and that levofloxacin should be studied more intensively for the treatment of typhoid fever.

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Last updated January, 2005