Comparative Efficacy of Meropenem Versus Meropenem Combined with Azithromycin in Treating Extensively Drug-Resistant Uncomplicated Typhoid Fever

OBJECTIVES To compare the effectiveness of treating children with meropenem monotherapy vs meropenem plus azithromycin for cases of unexplained typhoid fever that have developed resistance to other drugs. METHODOLOGY This study aimed to compare the clinical efficacy and safety of meropenem alone versus meropenem combined with azithromycin in treating pediatric patients with XDR uncomplicated typhoid fever in a randomised controlled trial (ClinicalTrials.gov Identifier: NCT07445282). Over 6 months, a randomised controlled trial was conducted at the Department of Pediatric Medicine at Sheikh Zayed Hospital in Rahim Yar Khan. Ninety children, aged six months to under five years, with blood-culture–confirmed XDR S. Typhi were included and randomly divided into two groups. Group A received meropenem IV (20–40 mg/kg every 8 hours), and Group B received meropenem and azithromycin by mouth (20 mg/kg/day). The main goal was the average time it took for the fever to go down. We used SPSS version 25.0 to analyse the data, setting the p-value to 0.05. RESULTSThe mean time to defervescence was significantly shorter in the combination group (5.4 ± 2.1 days) than in the meropenem group (6.5 ± 2.8 days; p = 0.02). In the combination group, 93.3% of patients saw clinical improvement, while in the monotherapy group, only 82.2% did (p = 0.04). The dual regimen significantly reduced the mean time to ovulation and the frequency of clinical alterations, without a significant increase in adverse events, compared with the monotherapy or the combination therapy in young children with severe drug-resistant (XDR) straightforward fever. CONCLUSION This study provides substantial evidence for optimising antibiotic therapy in pediatric XDR tachycardia by systematically assessing the clinical outcomes of two therapeutic regimens. The results are anticipated to enhance clinical practice, inform antibiotic stewardship initiatives, and support the global effort to mitigate antimicrobial resistance.