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ABSTRACT: Background
Fluoroquinolones are the most commonly used group of antimicrobials for the treatment of enteric fever, but no direct comparison between two fluoroquinolones has been performed in a large randomised trial. An open-label randomized trial was conducted to investigate whether gatifloxacin is more effective than ofloxacin in the treatment of uncomplicated enteric fever caused by nalidixic acid-resistant Salmonella enterica serovars Typhi and Paratyphi A.Methodology and principal findings
Adults and children clinically diagnosed with uncomplicated enteric fever were enrolled in the study to receive gatifloxacin (10 mg/kg/day) in a single dose or ofloxacin (20 mg/kg/day) in two divided doses for 7 days. Patients were followed for six months. The primary outcome was treatment failure in patients infected with nalidixic acid resistant isolates. 627 patients with a median age of 17 (IQR 9-23) years were randomised. Of the 218 patients with culture confirmed enteric fever, 170 patients were infected with nalidixic acid-resistant isolates. In the ofloxacin group, 6 out of 83 patients had treatment failure compared to 5 out of 87 in the gatifloxacin group (hazard ratio [HR] of time to failure 0.81, 95% CI 0.25 to 2.65, p?=?0.73). The median time to fever clearance was 4.70 days (IQR 2.98-5.90) in the ofloxacin group versus 3.31 days (IQR 2.29-4.75) in the gatifloxacin group (HR?=?1.59, 95% CI 1.16 to 2.18, p?=?0.004). The results in all blood culture-confirmed patients and all randomized patients were comparable.Conclusion
Gatifloxacin was not superior to ofloxacin in preventing failure, but use of gatifloxacin did result in more prompt fever clearance time compared to ofloxacin.Trial registration
ISRCTN 63006567 (www.controlled-trials.com).
SUBMITTER: Koirala S
PROVIDER: S-EPMC3837022 | biostudies-literature | 2013
REPOSITORIES: biostudies-literature
Koirala Samir S Basnyat Buddha B Arjyal Amit A Shilpakar Olita O Shrestha Kabina K Shrestha Rishav R Shrestha Upendra Man UM Agrawal Krishna K Koirala Kanika Deshpande KD Thapa Sudeep Dhoj SD Karkey Abhilasha A Dongol Sabina S Giri Abhishek A Shakya Mila M Pathak Kamal Raj KR Campbell James J Baker Stephen S Farrar Jeremy J Wolbers Marcel M Dolecek Christiane C
PLoS neglected tropical diseases 20131031 10
<h4>Background</h4>Fluoroquinolones are the most commonly used group of antimicrobials for the treatment of enteric fever, but no direct comparison between two fluoroquinolones has been performed in a large randomised trial. An open-label randomized trial was conducted to investigate whether gatifloxacin is more effective than ofloxacin in the treatment of uncomplicated enteric fever caused by nalidixic acid-resistant Salmonella enterica serovars Typhi and Paratyphi A.<h4>Methodology and princip ...[more]