We evaluated the response to
therapy in a series of 876 children consecutively admitted to The Aga Khan University Hospital with culture-proven
typhoid, including 281 cases infected with multi-
drug-resistant (MDR) strains. Among sensitive isolates there was no significant difference in cure rates, failure rates and time to defervescence with either
ampicillin or
chloramphenicol. Of the 217 children with MDR
typhoid who received
therapy with
third-generation cephalosporins, the outcome was significantly better with intravenous
ceftriaxone compared with
cefotaxime. Despite comparable cure rates, the time to defervescence was significantly longer among MDR strains treated with
ceftriaxone versus sensitive strains (mean (SD): 7.2 (3.4) versus 6.3 (29) days; p < 0.05). Earlier recognition and introduction of appropriate second-line
therapy has allowed us to reduce the case fatality rates of
typhoid to under 1%. Although a 14-day course of
ceftriaxone can be used successfully to treat most children hospitalized with MDR
typhoid, there is a need to evaluate the role of short-course
therapy or alternative therapeutic agents.