Comparison of efficacy of intravenous ceftraixone versus oral azithromycin in uncomplicated enteric fever.

Objective: To compare the efficacy of intravenous ceftriaxone vs oral azithromycin in uncomplicated enteric fever. Study Design: Prospective Cohort study. Setting: Department of Pediatric, The National Institute of Child Health Karachi, Period: 23 January 2024 to 22 July 2024. Methods: 160 patients presented with uncomplicated enteric fever were distributed randomly in ceftriaxone and azithromycin group. Children in the ceftriaxone group received the dose of 75 mg/kg/day intravenously in 2 divided doses, while children in the azithromycin group received the dose of 20 mg/kg/day as a single oral dose for 7 days. Clinical and microbiological efficacy were confirmed on resolution of all symptoms and negative blood culture for Salmonella typhi, respectively. Results: Clinical cure was significantly (p-value = 0.027) higher with oral azithromycin than with intravenous ceftriaxone [77 (96.3%) vs. 68 (85.0%)]. Microbiological cure was significantly (p-value = 0.028) higher with oral azithromycin than with intravenous ceftriaxone [80 (100.0%) vs. 74 (92.5%)]. The mean duration to become afebrile after initiating treatment was also significantly (p<0.001) shorter with oral azithromycin than with intravenous ceftriaxone [3.98 ± 0.80 days vs. 5.40 ± 1.62 days]. Conclusion: Oral azithromycin is more effective than intravenous ceftriaxone in the management of uncomplicated enteric fever with respect to clinical cure, microbiological cure and duration to become afebrile.